Immune-mediated diseases carry increased risk of thromboembolic events

Patients with immune-mediated diseases (IMD) are at heightened risk of thromboembolic events (TEs), with risk factors including age, comorbidities, and exposure to certain medications, a study reports.

The study included 182,431 patients with IMD (ie, ankylosing spondylitis, atopic dermatitis, inflammatory bowel disease, multiple sclerosis, psoriasis, psoriatic arthritis, rheumatoid arthritis, and systemic lupus erythematosus) and an identical number of individuals without an IMD diagnosis (control).

The mean age of the entire population was 51.3 years, and the majority (64.3 percent) were female. At baseline, significantly more patients in the IMD vs the control group had ≥1 TE (4.1 percent vs 2.7 percent; p<0.0001). Likewise, TE occurred with significantly greater frequency in the IMD group throughout the study period, with an incidence rate of 0.173 per person-year (total: 249,799) as opposed to 0.096 per person-year (total: 232,220) in the control cohort.

Adjusted generalized linear models confirmed that IMD was associated with a higher rate of TEs (adjusted incidence rate ratio [aIRR], 1.49, 95 percent confidence interval, 1.40–1.59; p<0.0001). Results were similar across individual TEs (deep vein thrombosis [DVT]: aIRR, 1.78; pulmonary embolism [PE]: aIRR, 1.66; myocardial infarction [MI]: aIRR, 1.17; ischaemic stroke [IS]: aIRR, 1.35; p<0.05 for all).

In terms of risk factors, age was positively associated with TE, with each additional year of age conferring an increase in the rate of all types of TEs. TE at baseline, on the other hand, showed the strongest link to TE incidence. For example, patients with baseline DVT were 41.1 times as likely as those who were free of it to experience DVT during the study period (p<0.001).

Comorbidities, including cardiovascular diseases, type 2 diabetes, and peripheral vascular disease, contributed to increased rates of MI (IRRs, 2.60, 1.30, and 1.54, respectively; p<0.05) and IS (IRRs, 1.53, 1.54, and 1.24, respectively; p<0.05).

Finally, use of Janus kinase inhibitors was associated with an increased rate of PE (IRR, 2.52; p<0.05) and nonsignificantly higher rates of DVT (IRR, 1.23) and IS (IRR, 1.82). On the other hand, use of sphingosine 1-phosphate receptor modulators tended to be protective against TEs (DVT: IRR, 0.61, nonsignificant; PE: IRR, 0.30, nonsignificant; MI: IRR, 0.54, nonsignificant; IS: IRR, 0.33, p<0.05).