Use of Tumor Necrosis Factor Alpha Inhibitors for Inflammatory Bowel Disease Patients with Concurrent Heart Failure

Prescribing information for tumor necrosis factor alpha (TNF alpha) inhibitors, a mainstay of treatment for moderate to severe inflammatory bowel disease (IBD), instructs cautious use in those with heart failure (HF). However, the limited data behind these warnings are inconclusive and should be weighed against mounting evidence demonstrating worse cardiac outcomes in active IBD. To assess whether TNF alpha inhibitor use is reduced in patients with IBD and HF by analyzing physician practice and prescription patterns. Using a Stanford University database, we queried TNF alpha inhibitor prescriptions in 8905 patients with an ICD-9 diagnosis of Crohn's disease or ulcerative colitis. Detailed chart review analysis was done for patients with a concurrent diagnosis of HF who were prescribed anti-TNF alpha agents. In addition, we collected survey data from 25 gastroenterologists on their usage of these drugs for patients with IBD and HF. TNF alpha inhibitors were prescribed to 10/455 (2.2%) IBD patients with HF compared to 1265/8450 (15.0%) in IBD patients without HF (p < 0.0001). Of those ten with HF prescribed TNF alpha inhibitors, only one had it discontinued because of HF exacerbation while on drug. Survey data indicated few (5/25) providers do not actively avoid TNF alpha inhibitors for those with HF. IBD patients with HF are prescribed significantly less TNF alpha inhibitors than those without HF. The majority of providers are either uncertain about or actively avoid use of anti-TNF alpha medications for those with HF. The risks and benefits of anti-TNF alpha use in HF patients must be investigated further.