Swedish cohort links rituximab use in MS with higher IBD risk

A population-based cohort study in Sweden compared new-onset inflammatory bowel disease (IBD) after several multiple sclerosis therapies and in the general population. IBD incidence was higher during rituximab treatment than with comparator disease-modifying therapies, although the observational findings do not establish causation.

IBD incidence was higher with rituximab than comparator MS therapies.
The study recorded 40 IBD events during rituximab episodes.
Observational results show association, not causation.
Authors highlight gastrointestinal symptom vigilance during anti-CD20 therapy.

Researchers used Swedish multiple sclerosis registry data to identify treatment initiations from 2011 through 2023 among people aged 18 to 55 years with relapsing-remitting multiple sclerosis and no recorded history of IBD. The study included 13,748 therapy episodes in 9,251 people: 6,481 with rituximab, 2,976 with natalizumab, 2,767 with dimethyl fumarate and 1,524 with fingolimod. These were compared with 61,065 matched general-population episodes. New-onset IBD required at least two diagnostic records on separate dates.

There were 40 IBD events during rituximab episodes, four during comparator-therapy episodes and 120 in the general population. Crude incidence rates per 100,000 person-years were 110 (95% CI, 76-147) with rituximab, 13 (95% CI, 3-30) with comparator therapies and 41 (95% CI, 34-48) in the general population. After adjustment, the hazard ratio for comparator therapies versus rituximab was 0.10 (95% CI, 0.04-0.22). At five years, the adjusted number needed to harm for rituximab versus comparator therapies was 131 (95% CI, 93-228).

This Swedish observational study found an association, not proof that rituximab causes IBD. The authors say IBD risk should be considered in treatment decisions and gastrointestinal symptoms monitored during anti-CD20 therapy. The findings may not apply to other populations or treatment settings.

In practice

For adults aged 18 to 55 years with relapsing-remitting MS and no recorded prior IBD, this Swedish cohort found more new-onset IBD during rituximab episodes than during comparator DMT episodes. The authors suggest considering IBD risk in treatment decisions and remaining alert to gastrointestinal symptoms during anti-CD20 therapy. This is observational evidence and cannot establish that rituximab caused IBD; the small number of events in the comparator-treatment group and the Swedish setting also limit certainty and generalisability. The findings do not establish a reason to change treatment on their own.

AI-generated clinical interpretation · Not editor-reviewed

AI summary · Not yet editor-reviewed

Is this summary clinically accurate?

Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.

Source

JAMA Neurology: Risk of Inflammatory Bowel Disease After Anti-CD20 Treatment in Multiple Sclerosis ↗

This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.