β-Blocker use is associated with a higher relapse risk of inflammatory bowel disease: a Dutch retrospective case-control study

Objective Inflammatory bowel disease (IBD) is a multifactorial disease and many factors may influence the disease course, like the concomitant use of medication. An example thereof is the use of beta-blockers, antagonizing beta-adrenergic receptors. beta-adrenergic receptor activation has potent anti-inflammatory effects on the immune system. We addressed whether an association exists between the use of beta-blockers and the course of IBD, defined by the risk of a disease relapse in patients with IBD. Patients and methods In this retrospective case-control study, we used a population-based cohort of patients with IBD. We identified colitis relapses using IBD medication prescriptions as a proxy. We calculated the number of relapses per 100 person-years and compared this between patients with IBD using beta-blockers and patients with IBD not using beta-blockers. We used Cox proportional hazards models with shared frailty to compare the relative relapse risk between both groups. Results A total of 250 patients with IBD were included, of which 30 patients used a beta-blocker for at least 3 months. With the Cox proportional hazards model with shared frailty, adjusted for age and sex, we observed a 54% (hazard ratio: 1.54; 95% confidence interval: 1.05-2.25; P= 0.03) higher risk of a relapse in the group of patients with IBD using beta-blockers versus the group not using beta-blockers. Conclusion Even in this limited cohort study, we show that patients with IBD using beta-blockers have an increased relapse risk. Indeed, concomitant medication use seems to be a factor that can influence the course of IBD, and this should be acknowledged while making decisions about treatment of IBD and follow-up. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.