Cerebrovascular events in inflammatory bowel disease patients treated with anti-tumour necrosis factor alpha agents.
OBJECTIVE
Cerebrovascular accidents [CVA] have rarely been reported in inflammatory bowel disease [IBD] patients treated with anti-tumour necrosis alpha [anti-TNF alpha] agents. Our aim here was to describe the clinical course of CVA in these patients.


METHODS
This was a European Crohn's and Colitis Organisation [ECCO] retrospective observational study, performed as part of the CONFER [COllaborative Network For Exceptionally Rare case reports] project. A call to all ECCO members was made to report on IBD patients afflicted with CVA during treatment with anti-TNF alpha agents. Clinical data were recorded in a standardised case report form and analysed for event association with anti-TNF alpha treatment.


RESULTS
A total of 19 patients were identified from 16 centres: 14 had Crohn's disease, four ulcerative colitis and one IBD colitis unclassified [median age at diagnosis: 38.0 years, range: 18.6-62.5]. Patients received anti-TNF alpha for a median duration of 11.8 months [range: 0-62] at CVA onset; seven had previously been treated with at least one other anti-TNF alpha agent. Complete neurological recovery was observed in 16 patients. Anti-TNF alpha was discontinued in 16/19 patients. However, recurrent CVA or neurological deterioration was not observed in any of the 11 patients who received anti-TNF alpha after CVA [eight resumed after temporary cessation, three continued without interruption] for a median follow-up of 39.8 months [range: 5.6-98.2].


CONCLUSIONS
These preliminary findings do not unequivocally indicate a causal role of anti-TNF alpha in CVA complicating IBD. Resuming or continuing anti-TNF alpha in IBD patients with CVA may be feasible and safe in selected cases, but careful weighing of IBD activity versus neurological status is prudent.
Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece kkarmiris@gmail.com.
Konstantinos
K
Karmiris
Imelda GI Clinical Research Center, Bonheiden, Belgium.
Peter
P
Bossuyt
IBD Center, Virginia Tech-Carilion School of Medicine, Roanoke, VA, USA and Department of Clinical and Experimental Medical Sciences, University of Udine School of Medicine, Udine, Italy.
Dario
D
Sorrentino
Department of Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Tom
T
Moreels
Department of Gastroenterology, Azienda University Hospital, Policlinico di Modena, Italy.
Antonella
A
Scarcelli
Gastroenterology Unit, Segovia General Hospital, Segovia, Spain.
Jesus
J
Legido
IBD Center, Department of Gastroenterology and Liver Diseases and the Sackler School of Medicine, Sourasky Medical Center, Tel Aviv, Israel.
Iris
I
Dotan
Department of Gastroenterology, Paisley RAH, Glasgow, Scotland.
Graham D
GD
Naismith
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
Airi
A
Jussila
Charité-Universitätsmedizin, Berlin, Germany.
Jan C
JC
Preiss
Charité-Universitätsmedizin, Berlin, Germany.
Wolfgang
W
Kruis
Department of Gastroenterology, Western Sussex Hospitals NHSFT, Worthing, UK.
Andy C Y
AC
Li
Department of Gastroenterology, University Hospital Pontchaillou, Rennes, France.
Guillaume
G
Bouguen
Gastroenterology Unit, Segovia General Hospital, Segovia, Spain.
Henit
H
Yanai
IBD Unit, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
Flavio
F
Steinwurz
Division of Gastroenterology, University Hospital of Ioannina, Greece.
Konstantinos H
KH
Katsanos
Gastroenterology and Hepatology Unit, Canberra Hospital, Canberra, Australia.
Kavitha
K
Subramaniam
Department of Gastroenterology, MMA Belgrade, Serbia.
Dino
D
Tarabar
Department of Neurology, University Hospital of Heraklion, Heraklion, Crete, Greece.
Ioannis V
IV
Zaganas
Department of Gastroenterology, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
Shomron
S
Ben-Horin
D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology*; D000068582:Certolizumab Pegol / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy*; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D035583:Rare Diseases / Q000175:diagnosis / Q000209:etiology*; D019233:Retreatment; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D001379:Azathioprine; D000068582:Certolizumab Pegol; D008727:Methotrexate
Cerebrovascular accidents; anti-TNF alpha agents; inflammatory bowel disease