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Impact of Angiotensin II Signaling Blockade on Clinical Outcomes in Patients with Inflammatory Bowel Disease

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Abstract

Background

Preclinical data demonstrate that activation of the renin–angiotensin system (RAS) contributes to mucosal inflammation, and RAS inhibition by angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) improves colitis in animal models. Less is known regarding the effects of RAS inhibition on clinical outcomes in inflammatory bowel disease (IBD) patients.

Aim

Evaluate the impact of ACEI and ARB on clinical outcomes in IBD.

Methods

Rates of IBD-related hospitalizations, operations, and corticosteroid use were evaluated retrospectively in two groups. First, 111 IBD patients taking an ACEI or ARB were compared to nonusers matched 1:1 based on sex, age, diagnosis, disease location, and hypertension diagnosis. Second, outcomes in a cohort of 130 IBD patients were compared prior to and during ACEI/ARB exposure.

Results

Compared to matched controls, all IBD patients together with ACEI/ARB exposure had fewer hospitalizations (OR 0.26, p < 0.01), operations (OR 0.08, p = 0.02), and corticosteroid prescriptions (OR 0.5, p = 0.01). Comparing outcomes before and during ACEI/ARB use, there were no differences in hospitalizations, operations, or corticosteroid use for all IBD patients together, but patients with UC had increased hospitalizations (0.08 pre- vs. 0.16 during ACEI/ARB exposure, p = 0.03) and decreased corticosteroid use (0.24 pre-ACEI/ARB vs. 0.12 during ACEI/ARB exposure, p < 0.01) during ACEI/ARB use.

Conclusions

IBD patients with ACEI/ARB exposure had fewer hospitalizations, operations, and corticosteroid use compared to matched controls. No differences in outcomes were observed in individuals on ACEI/ARB therapy when compared to a period of time prior to medication exposure.

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Funding

National Institute of Diabetes and Digestive and Kidney Diseases, Grant Number P30 DK42086 and National Institutes of Health, Grant Number K08 DK090152 (JP).

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA

    Jeffrey D. Jacobs

  2. Department of Medicine, University of Chicago, Chicago, IL, USA

    Thomas Wagner

  3. Center for Research Informatics, University of Chicago, Chicago, IL, USA

    George Gulotta

  4. Department of Public Health Sciences, University of Chicago, Chicago, IL, USA

    Chuanhong Liao

  5. Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago, 900 East 57th St., MB #9, Chicago, IL, 60637, USA

    Yan Chun Li, Marc Bissonnette & Joel Pekow

Authors
  1. Jeffrey D. Jacobs
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  2. Thomas Wagner
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  3. George Gulotta
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  4. Chuanhong Liao
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  5. Yan Chun Li
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  7. Joel Pekow
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Correspondence to Joel Pekow.

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Jacobs, J.D., Wagner, T., Gulotta, G. et al. Impact of Angiotensin II Signaling Blockade on Clinical Outcomes in Patients with Inflammatory Bowel Disease. Dig Dis Sci 64, 1938–1944 (2019). https://doi.org/10.1007/s10620-019-5474-4

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  • DOI: https://doi.org/10.1007/s10620-019-5474-4

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