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

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 β-blockers, antagonizing β-adrenergic receptors. β-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. 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 β-blockers and patients with IBD not using β-blockers. We used Cox proportional hazards models with shared frailty to compare the relative relapse risk between both groups. A total of 250 patients with IBD were included, of which 30 patients used a β-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 β-blockers versus the group not using β-blockers. Even in this limited cohort study, we show that patients with IBD using β-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