Cardiovascular risk assessment recommended before use of small-molecule drugs in IBD
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Key takeaways:
- Cardiovascular risk-screening and stratification is advised for IBD patients before JAK inhibitor or S1P modulator use.
- Evidence does not indicate a higher risk for cardiovascular events with JAK inhibitors.
Although evidence suggests the risk for cardiovascular events with small-molecule drugs is low in patients with inflammatory bowel disease, experts advise screening for risk factors and stratification before initiation of therapy.
“Janus kinase (JAK) inhibitors and sphingosine 1 phosphate (S1P) receptor modulators are classes of small-molecule drugs that have been approved by the FDA and/or the European Medicines Agency for IBD treatment,” Pablo A. Olivera, of the IBD unit at the Center for Medical Education and Clinical Research in Buenos Aires, Argentina, and colleagues wrote in Digestive and Liver Disease. “Despite their potential benefits, JAK inhibitors and S1P modulators may be associated with cardiovascular safety concerns, which may limit their use in clinical practice.”
They continued: “Hence, there is a need to develop strategies to mitigate cardiovascular risks and ensure the safe use of [small-molecule drugs] in IBD while allowing an adequate physician-patient interaction around the decision to use these therapies.”
To address this need, Olivera and colleagues performed a systematic literature search to identify studies investigating the risk for cardiovascular events associated with JAK inhibitors and S1P receptor modulators in patients with IBD. Two study authors developed proposed statements based on search results, which were reviewed by an international group of 11 IBD experts and two cardiovascular specialists during a virtual Delphi consensus meeting.
Participants voted anonymously on the proposed statements, each of which required at least 75% agreement to pass.
Highlights for 18 statements that reached consensus include:
- Evidence does not indicate a higher risk for cardiovascular events with JAK inhibitors.
- Cardiovascular risk factors and history of atherosclerotic cardiovascular events influence the risk for events with JAK inhibitor use, which should be weighed against risks associated with uncontrolled inflammation.
- All patients with IBD should be screened for cardiovascular risk factors, along with risk-stratification, which should also be done before initiation of JAK inhibitors or S1P receptor modulators.
- When initiating JAK inhibitors, providers should measure the lipid profile at baseline, after induction and every 6 months thereafter.
- Providers should aim to administer the lowest effective dose to maintain remission with JAK inhibitors and avoid a higher maintenance dose in patients with known cardiovascular risk factors.
- For IBD patients with a history of atherosclerotic cardiovascular disease or at significant risk, JAK inhibitors should be considered when no other suitable alternatives exist.
- All patients with IBD should receive counseling and education on cardiovascular risk, as well as encouragement for healthy lifestyle modifications.
- Blood pressure should be routinely checked in patients treated with S1P modulators.
“The aim of this consensus is to provide practical advice, based on the available evidence, to help clinicians minimize the cardiovascular risk of small molecule drugs while communicating information to patients in a way that enables adequate informed decisions,” Olivera and colleagues wrote. “Specific management of established cardiovascular disease and risk factors is outside the scope of this consensus and gastroenterologists should consult primary care physicians and cardiovascular specialists for support in these cases.”
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