Anti-TNF Treatment Associated With Improved Pulmonary Obstruction in Active Inflammatory Bowel Disease

Patients with active inflammatory bowel disease (IBD) have been found to have significant obstructive abnormalities on pulmonary function tests compared with patients who are in remission, but treatment with anti-tumor necrosis factor (anti-TNF) agents can generally improve pulmonary obstruction in patients with active disease, according to the results of a study published in the Journal of Crohn’s and Colitis.

Researchers conducted a study involving 92 consecutive patients with IBD from an outpatient IBD center in Germany. The cohort included 49 patients with Crohn disease and 43 patients with ulcerative colitis, as well as 20 people without either condition in the control group. Among the patients with IBD, 50 were in remission and 42 had active disease. Patients with active disease were examined prior to and 6 weeks after starting anti-TNF therapy.

Mean ages in the remission and active disease groups were 44.78 and 49.4 years, respectively. The researchers used the Medical Research Council dyspnea index and a standardized body plethysmography to evaluate pulmonary function, while the Harvey-Bradshaw index and partial Mayo score were used to assess Crohn disease and ulcerative colitis activity, respectively.

Active IBD was associated with significant reduction in respiratory function. A significantly greater proportion of patients with active IBD had central or peripheral airway obstruction compared with those in remission (31.9% vs 6.9%, respectively; P =.006).

Additionally, forced expiration values (FEV1%) were significantly reduced in patients with active IBD (78.8±1.1) compared with both those in remission (86.1±0.9; P =.0002) and with participants in the control group (87.3±1.3; P =.06). The use of anti-TNF agents was found to be associated with a significant relief in obstruction (P =.003).

A limitation of this study was the investigators’ inability to determine whether improvement in pulmonary function occurred as a direct result of treatment with anti-TNF agents or if other factors were at play.

Based on the study’s limitations, the researchers concluded that additional research is necessary to identify how to appropriately address pulmonary involvement in patients with IBD.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Ellrichmann M, Bethge J, Boesenkoetter J, et al. Subclinical pulmonary involvement in active IBD responds to biological therapy. J Crohns Colitis. Published online February 5, 2021. doi:10.1093/ecco-jcc/jjab024