Skip to Main content Skip to Navigation
Theses

Risque d'accident artériel aigu chez les patients atteints de maladie inflammatoire chronique intestinale et impact des traitements sur le risque : analyse des bases de données médico administratives françaises PMSI et SNIIRAM

Abstract : The risk of acute arterial events in inflammatory bowel disease (IBD) remains unclear. The objectives of this thesis are to assemble a nationwide cohort of IBD patients based on the French administrative health databases, in order to assess the risk of acute arterial events in IBD and the impact of immunosuppressive treatment on the risk. Disease course and therapeutic management of IBD were first studied, in order to validate the coding diagnosis of IBD in the databases. Treatment exposure, hospitalisation, and surgery rates are similar to current standard of care and incidence rates are in the range of those reported in other populations. Patients with Crohn’s disease (CD) and ulcerative colitis (UC) have an increased risk of acute arterial events compared with the general population. The highest risk is observed in patients under the age of 55 years. Disease activity is an independent risk factor of acute arterial events, with a similar magnitude of risk in CD and UC. Exposure to thiopurine and anti-TNF monotherapies, and combination therapy are all numerically associated with a decreased risk of acute arterial events compared to unexposed patients, although the difference is only statistically significant for patients exposed to combination therapy. The magnitude in risk reduction is highest in men with CD exposed to combination therapy. These studies support the concept that a tight control of inflammation is crucial in patients with IBD to avoid IBD-related systemic complications. Prevention of acute arterial events should be considered in the benefit-risk balance assessment of thiopurines and anti-TNFs treatment in IBD patients, according to age, sex and IBD subtype.
Document type :
Theses
Complete list of metadatas

Cited literature [293 references]  Display  Hide  Download

https://tel.archives-ouvertes.fr/tel-02411564
Contributor : Abes Star :  Contact
Submitted on : Sunday, December 15, 2019 - 1:02:30 AM
Last modification on : Friday, August 21, 2020 - 6:54:45 AM
Long-term archiving on: : Monday, March 16, 2020 - 1:21:37 PM

File

2017PA066634.pdf
Version validated by the jury (STAR)

Identifiers

  • HAL Id : tel-02411564, version 1

Citation

Julien Kirchgesner. Risque d'accident artériel aigu chez les patients atteints de maladie inflammatoire chronique intestinale et impact des traitements sur le risque : analyse des bases de données médico administratives françaises PMSI et SNIIRAM. Médecine humaine et pathologie. Université Pierre et Marie Curie - Paris VI, 2017. Français. ⟨NNT : 2017PA066634⟩. ⟨tel-02411564⟩

Share

Metrics

Record views

204

Files downloads

115