What are the long-term effects of ARBs, ACEIs in patients with Crohn’s disease?

Use of angiotensin-converting enzyme inhibitors (ACEIs) often results in a poorer disease course at 5 and 10 years, whereas treatment with angiotensin receptor blockers (ARBs) is associated with fewer cases of corticosteroid use at 10 years, reports a study involving patients with Crohn’s disease (CD).

A team of investigators enrolled CD patients initiated on an ACEI or ARB between 2000 and 2016 in this retrospective study. They obtained data on clinical, radiologic, and procedural surrogate markers of inflammatory bowel disease in the subsequent 3, 5, and 10 years. Using univariate and multivariate analyses, the investigators then compared these data with those of matched controls.

At 10 years, patients treated with ARBs were less likely to use corticosteroids than control participants (1.06 vs 2.88; p<0.01).

On the other hand, patients who received ACEIs experienced an overall worse disease course, with more imaging studies (3.00 vs 1.75; p=0.03) and endoscopic procedures (2.70 vs 1.78; p=0.01) at 5 years, and more imaging studies (6.19 vs 3.50; p<0.01), endoscopic procedures (5.91 vs 3.78; p<0.01), and gastrointestinal operations (0.59 vs 0.18; p<0.02) at 10 years.

These results were consistent in multivariate analysis, adjusted for CD characteristics and the use of other antihypertensive drugs.

“Our study provides insight into the long-term use of renin-angiotensin-aldosterone system-blocking agents in patients with CD, suggesting that differences exist among commonly prescribed medication classes,” the investigators said. “Future large-scale studies are needed to further explore this association.”