Angiotensin receptor blockers ‘may not be safe,’ worsen outcomes for celiac disease
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Key takeaways:
- Angiotensin receptor blockers were linked to worse outcomes in patients with celiac disease.
- Patients exhibited higher risk for persistent symptoms and “poor small bowel healing.”
PHILADELPHIA — Angiotensin receptor blockers were associated with worse outcomes in patients with celiac disease, including anemia, iron deficiency and “continued mucosal damage in the small intestine,” according to a presenter.
“This research was motivated by an experience in fellowship, where I saw someone in clinic with celiac disease and persistent symptoms who happened to be on an angiotensin receptor blocker,” Isabel A. Hujoel, MD, of the division of gastroenterology at the University of Washington, told Healio. “Understanding that these angiotensin receptor blockers can cause an enteropathy with many similarities to celiac disease, I wondered if these medications may exacerbate the underlying disease process and contribute to persistent symptoms.”
To determine if a link exists between angiotensin receptor blockers (ARBs) and poor outcomes in celiac disease, Hujoel and colleagues used electronic medical records from the All of us biomedical database to identify 1,849 patients with celiac disease (median age, 49.8 years; mostly women) based on Systematized Nomenclature of Medicine terms
The researchers performed a survival analysis, dividing patients into three groups: those diagnosed with celiac disease but not prescribed an angiotensin receptor blocker (n=1,587), those prescribed the drug prior to diagnosis (n=120) and those prescribed the drug after diagnosis (n=142).
They evaluated time from diagnosis to development of first outcome of interest, including persistent symptoms, such as diarrhea, weight loss and abdominal pain, as well as surrogate markers for malabsorption: iron deficiency, vitamin deficiencies and anemia.
“We found that those with celiac disease who were prescribed an angiotensin receptor blocker were more likely to experience anemia, iron deficiency, abdominal pain and diarrhea [vs.] those [who were] not prescribed an angiotensin receptor blocker,” Hujoel told Healio.
However, ARB use did not increase patient risk for weight loss and vitamin deficiency, she said.
During the ACG Annual Scientific Meeting, Hujoel told attendees that patients who received ARBs exhibited signs of persistent symptoms and were “more likely to have surrogate markers for malabsorption, suggesting they may have poor small bowel healing.”
Additionally, she noted that patients who had been using ARBs prior to their celiac disease diagnosis were at risk for being misdiagnosed with celiac disease when they had ARB-induced enteropathy.
To assess whether poor outcomes in patients were predominantly associated with ARB use after disease diagnosis, the researchers performed a separate sensitivity analysis, excluding all patients who had been prescribed ARBs prior to celiac diagnosis. Hujoel and colleagues observed that patients “still had a significant increased risk” for low hemoglobin (all patients on ARBs: hazard ratio= 1.86; 95% CI, 1.48-2.33 vs. prescribed ARBs after diagnosis: HR= 1.98; 95% CI, 1.35-2.92) and iron deficiency (all on ARBs: HR= 1.7; 95% CI, 1.28-2.26 vs. prescribed ARBs after diagnosis: HR= 1.72; 95% CI, 1.07-2.75).
“Angiotensin receptor blockers may not be a safe medication class to use for those with celiac disease, as they may lead to both persistent symptoms and possible continued mucosal damage in the small intestine,” Hujoel told Healio. “[However,] future research is therefore needed, ideally a randomized double-blind study looking at those with biopsy proven celiac disease and including data on mucosal healing.”
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Hujoel IA, et al. The safety of angiotensin receptor blockers in celiac disease. Presented at: ACG Annual Scientific Meeting; Oct. 25-30, 2024; Philadelphia (hybrid meeting).
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