Anti-CD20 MS Treatment Linked to Higher IBD Risk, Study Finds
Anti-CD20 treatment in multiple sclerosis carries a higher risk of inflammatory bowel disease than other modern disease-modifying therapies, according to a Swedish population-based cohort study published in JAMA Neurology. The analysis evaluated therapy episodes initiated between January 2011 and December 2023 among individuals aged 18 to 55 years with relapsing-remitting multiple sclerosis and no prior history of inflammatory bowel disease.
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Key Clinical Takeaways:
- The crude incidence rate of new-onset inflammatory bowel disease reached 110 per 100,000 person-years for patients receiving rituximab, compared with 13 per 100,000 person-years for comparator disease-modifying therapies.
- Crohn disease accounted for 62% of inflammatory bowel disease events among patients treated with rituximab, compared with 29% in matched general population comparators.
- Thirty percent of individuals who developed inflammatory bowel disease while on rituximab discontinued the therapy just before or within two years of their diagnosis.
Researchers Track Gastrointestinal Safety Across Four Multiple Sclerosis Therapies
To evaluate the gastrointestinal safety profile of modern multiple sclerosis therapies, researchers identified therapy initiations across four major disease-modifying agents: rituximab, natalizumab, dimethyl fumarate, and fingolimod. The study tracked 13,748 therapy episodes across 9,251 individual patients, alongside 61,065 matched general population comparator episodes. Among the evaluated treatments, rituximab represented 6,481 episodes, natalizumab comprised 2,976, dimethyl fumarate accounted for 2,767, and fingolimod covered 1,524 episodes.
During the follow-up period, investigators recorded 164 total inflammatory bowel disease events. Specifically, 40 events occurred among patients treated with rituximab, four events were documented across the comparator disease-modifying therapies, and 120 events appeared within the general population cohort. After adjusting for confounding variables, the hazard ratio for comparator disease-modifying therapies versus rituximab stood at 0.10, indicating a lower risk of new-onset bowel disease with alternative agents. The number needed to harm for rituximab versus comparator therapies was calculated at 131 at five years.
Clinicians Should Monitor Inflammatory Bowel Disease Risk in Patients
The findings published by Kallin and colleagues indicate that clinicians and individuals managing relapsing-remitting multiple sclerosis should factor inflammatory bowel disease risk into treatment decisions. Because the investigation relied on an observational design, investigators emphasized that causality cannot be inferred from the statistical association alone. Nonetheless, the incidence warrants clinical vigilance for gastrointestinal symptoms among patients receiving anti-CD20 treatment.
Discontinuation patterns observed in the registry data further highlight the clinical complexity surrounding these gastrointestinal events. Thirty percent of patients who developed inflammatory bowel disease while taking rituximab stopped their multiple sclerosis treatment immediately prior to or within two years following their diagnosis.
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