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Preventing and managing cardiovascular events in patients with inflammatory bowel diseases treated with

Pablo A Olivera1, Axel Dignass2, Marla C Dubinsky3

  • 1IBD Unit, Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigación Clínica (CEMIC), Buenos Aires, Argentina; Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.

Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
|April 7, 2024
PubMed

Insights

Small molecule drugs (SMDs) like JAK inhibitors and S1P receptor modulators are used for inflammatory bowel disease (IBD). While generally safe, cardiovascular risk assessment is crucial before starting these IBD treatments.

Area of Science:

  • Gastroenterology
  • Cardiology
  • Pharmacology

Background:

  • Small molecule drugs (SMDs), including Janus kinase (JAK) inhibitors and sphingosine 1 phosphate (S1P) receptor modulators, are approved for inflammatory bowel disease (IBD) treatment.
  • Clinical use of these SMDs may be constrained by potential cardiovascular concerns.
  • Guidance is needed for risk assessment, monitoring, and management to mitigate cardiovascular risks associated with SMDs in IBD patients.

Purpose of the Study:

  • To provide expert consensus guidance on managing cardiovascular risks in IBD patients treated with SMDs.
  • To facilitate informed shared decision-making regarding the use of JAK inhibitors and S1P receptor modulators.

Main Methods:

  • A systematic literature search was performed to gather relevant evidence.
  • Proposed consensus statements were developed and reviewed.
  • An international virtual consensus meeting involving IBD physicians and cardiovascular specialists was conducted.
  • Anonymous voting determined agreement on consensus statements, with 75% consensus required.

Main Results:

  • Consensus was achieved on eighteen statements regarding cardiovascular risk management for IBD patients on SMDs.
  • Evidence suggests JAK inhibitors do not increase overall cardiovascular event risk in IBD, but risk may rise in patients with pre-existing cardiovascular risk factors.
  • S1P receptor modulators may be linked to bradycardia, atrioventricular blocks, and hypertension.

Conclusions:

  • Cardiovascular risk stratification is recommended prior to initiating JAK inhibitors or S1P receptor modulators for IBD.
  • While overall cardiovascular risk appears low, specific patient profiles and drug types necessitate careful consideration and monitoring.
  • Implementing these guidelines can help minimize cardiovascular risks and support optimal patient care in IBD management.

Keywords:
Cardiovascular eventsInflammatory bowel diseasePreventionSmall molecule drugs

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