S952 The Effect of Commonly Prescribed Renin-Angiotensin-Aldosterone System Blocking Agents on the 5- and 10-year Disease Course of Crohn’s Disease Patients With Hypertension
Notice bibliographique
Résumé
Introduction: Activation of the renin-angiotensin-aldosterone system (RAAS) has been associated with gastrointestinal inflammation and fibrosis, suggesting that blockade may be beneficial in patients with inflammatory bowel disease (IBD). Using retrospective analysis, we aimed to compare the disease course of Crohn’s disease (CD) patients initiated on two commonly prescribed classes of RAAS-blocking agents. Methods: Patients with CD and hypertension who were initiated on an angiotensin-converting-enzyme inhibitor (ACEI, n=40) or angiotensin-receptor blocker (ARB, n=40) between 2000-2016 were included. A control group (n=40) was created and matched on gender, body mass index, CD Montreal classification, age at CD diagnosis, CD duration, and common comorbid conditions. Data was collected on surrogate markers of IBD severity in the 3-, 5-, and 10-years following ACEI or ARB initiation. Surrogate markers included clinical (emergency department visits, hospitalizations, corticosteroid use, and biologic therapy use), radiological (computer tomography [CT], CT enterography, magnetic resonance imaging, magnetic resonance enterography), and procedural (endoscopic procedures, IBD-related operations) variables. Statistical analysis was performed by one-way multivariate analysis of variance with Tukey post-hoc testing. Results: Compared to control, patients taking ARBs had fewer instances of systemic corticosteroid use (1.06 vs.2.88, p< 0.01, -63%) at the 10-year interval. On the other hand, patients taking ACEIs had an overall worse disease course, with more imaging studies (3.00 vs.1.75, p=0.03, +71%) and endoscopic procedures (2.70 vs. 1.78, p=0.01, +52%) at 5-years, and more imaging studies (6.19 vs.3.50, p< 0.01, +77%), endoscopic procedures (5.91 vs.3.78, p< 0.01, +56%), and IBD-related operations (0.59 vs.0.18, p< 0.02, +228%) at 10-years. ACEI-treated patients were also more likely to initiate biologic therapy compared to control (56.0% vs.32.3%) and ARB-treated patients (56.0% vs.17.4%). Conclusion: Our study provides insight into the long-term use of RAAS-blocking agents in patients with CD, suggesting that differences exist between commonly prescribed medication classes. While ACEIs were associated with an overall worse disease course at 5- and 10-years, patients taking ARBs were noted to have fewer instances of corticosteroid use at 10-years. Given the frequent use of ACEI and ARB therapy, future large-scale studies are needed to further explore the association RAAS-blockade and IBD disease course (Table). Table 1. - Summary of clinical, radiological, and procedural surrogate markers of inflammatory bowel disease severity in the 3-, 5-, and 10-years following initiation of renin-angiotensin-aldosterone system blocking therapy Variable Average number of events per patient 3 years 5 years 10 years CD-ACEI (n= 40) CD-ARB (n= 40) CD-Control (n= 40) p-value CD-ACEI (n= 40) CD-ARB (n= 40) CD-Control (n= 40) p-value CD-ACEI (n= 32) CD- ARB (n= 33) CD-Control (n= 40) p-value Emergency department visits (all) 1.25 1.50 1.90 0.33 2.52 2.30 2.60 0.87 5.34 3.91 6.1 0.10 Emergency department visits (abdominal pain) 0.58 0.48 0.48 0.87 1.05 0.60 0.75 0.29 2.34 0.91 1.70 < 0.02 Hospitalizations (abdominal pain) 0.18 0.15 0.25 0.72 0.38 0.23 0.28 0.56 0.88 0.30 0.65 0.07 Systemic corticosteroid use (single instances) 0.63 0.35 1.00 0.09 1.53 0.45 1.28 0.03 3.72 1.06 2.88 < 0.01 Abdominal imaging 2.05 1.55 1.25 0.12 3.00 1.83 1.75 < 0.02 6.19 2.73 3.50 < 0.01 Endoscopic procedures 1.45 0.90 1.05 0.12 2.70 1.60 1.78 < 0.01 5.91 2.61 3.78 < 0.01 Gastrointestinal operations 0.13 0.08 0.08 0.72 0.15 0.10 0.08 0.18 0.59 0.15 0.18 < 0.01 Values are expressed as average number of events per patient at 3-, 5-, and 10-years following initiation of either an angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB). In case of control patients, values represent the average number of events per patient at 3-, 5-, and 10-years following start of follow-up interval. Emergency department visits included all visits as well as visits with abdominal pain as the chief complaint. Hospitalization included only those with abdominal pain as the chief complaint. Systemic corticosteroid usage was defined as single instances of systemic corticosteroid therapy. Abdominal imaging was defined as imaging of the abdominal area with Crohn’s disease as the primary indication. Endoscopic procedures included colonoscopy, sigmoidoscopy, double balloon enteroscopy, esophagogastroduodenoscopy. Gastrointestinal operations were defined as operations with Crohn's disease as the primary indication (including colectomy, small bowel resection, ileocecectomy, and proctocolectomy). ACEI: Angiotensin-converting-enzyme inhibitor, ARB: Angiotensin receptor blocker, CD: Crohn’s disease
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».