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Abstract Details
Antitumour Necrosis Factor-a Agents and Development of New-Onset Cirrhosis or Non-Alcoholic Fatty Liver Disease: A Retrospective Cohort
BMJ Open Gastroenterol. 2020 Apr 15;7(1):e000349.doi: 10.1136/bmjgast-2019-000349.eCollection 2020.
Kuo-Tung Tang123, Jean-François Dufour45, Po-Hung Chen6, Ruben Hernaez78, Susan Hutfless6
Author information
1Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.
2Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
3School of Medicine, National Yang-Ming University, Taipei, Taiwan.
4Department of Visceral Surgery and Medicine, Inselspital University Hospital Bern, Bern, Switzerland.
5Department of Biomedical Research, University of Bern, Bern, Switzerland.
6Division of Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
7Section of Gastroenterology, Michael E DeBakey VA Medical Center, Houston, Texas, USA.
8Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas, USA.
Free PMC article
Abstract
Objective: Elevated tumour necrosis factor (TNF)-α has been implicated in the progression of liver fibrosis and pathogenesis of non-alcoholic fatty liver disease (NAFLD). We aim to investigate the impact of anti-TNF-α agents on the development of cirrhosis and NAFLD.
Design: This retrospective cohort study used a US claims database between 1 January 2010 and 31 December 2016. We identified adult patients with ankylosing spondylitis, inflammatory bowel disease, psoriatic arthritis or rheumatoid arthritis. Anti-TNF-α agents of interest included adalimumab, certolizumab, etanercept, golimumab and infliximab. The primary composite outcome was the development of new-onset cirrhosis, NAFLD or non-alcoholic steatohepatitis (NASH). The secondary outcomes were the development of (1) cirrhosis and (2) NAFLD or NASH. Propensity score for anti-TNF-α agent use was generated by logistic regression. Cox proportional hazard models adjusting for the propensity score were used with regard to time-varying anti-TNF-α agent exposure.
Results: This study included 226 555 incident patients with immune-related diseases. During the median 1.5 years follow-up, there was an increased hazard with anti-TNF-α agent use in regard to liver outcomes (composite outcome HR: 1.47, 95% CI 1.27 to 1.70; cirrhosis HR 1.47, 95% CI 0.96 to 2.23; NAFLD or NASH HR 1.53, 95% CI 1.32 to 1.77). The composite outcome hazard was increased for each immune-related disease (HR 1.25-1.90).
Conclusion: In the short term, we did not observe a beneficial effect of anti-TNF-α agent use for development of cirrhosis, NAFLD or NASH in patients with immune-related diseases.