Caution Needed in Prescribing IBD Meds in CKD

TOPLINE:

Most inflammatory bowel disease (IBD) therapies — particularly biologic agents — appear safe in patients with chronic kidney disease (CKD); however, caution is required with certain conventional therapies, including immunomodulators and aminosalicylates, as well as with JAK inhibitors.

METHODOLOGY:

• From 4% to 23% of patients with IBD also have renal disease, which can affect how the body processes medications; however, little data is available to guide physicians in choosing safe and effective IBD treatments for patients with advanced CKD.
• Researchers conducted a review of studies about IBD treatments in the setting of CKD by searching MEDLINE and EMBASE through March 31, 2025, using relevant keywords.
• IBD treatments evaluated were corticosteroids, aminosalicylates, immunomodulators (such as thiopurines and methotrexate), calcineurin inhibitors, biologics (such as monoclonal antibodies against tumor TNFs (anti-TNFs), integrin receptors, and interleukins), and small molecules (such as JAK inhibitors and sphingosine-1-phosphate [S1P] receptor modulators).

TAKEAWAY:

• Corticosteroids in advanced kidney disease, including in patients requiring dialysis, do not require dosage adjustment. Budesonide is preferred over prednisolone, and corticosteroids are typically administered at the lowest effective dose for the shortest duration.
• Mesalazine, an aminosalicylate, can trigger acute interstitial nephritis; the immunomodulator methotrexate, even at 2-4 mg/wk, may cause irreversible renal decline, profound myelosuppression, and higher mortality in patients with end-stage kidney disease on hemodialysis; and calcineurin inhibitors can be nephrotoxic by reducing renal blood flow and glomerular filtration rate.
• Monoclonal antibodies, including anti-TNF, anti-integrin, and anti-interleukin 12/23 therapies, demonstrated safety in renal insufficiency and hemodialysis.
• For JAK inhibitors and thiopurines, dose adjustments were recommended in advanced renal disease, whereas S1P receptor modulators could be used in CKD without any dose adjustments.

IN PRACTICE:

“Selecting appropriate therapeutics for managing IBD in patients with CKD necessitates a tailored approach, emphasizing diligent surveillance of renal function to optimize treatment efficacy and minimize renal compromise. Dose adjustments of IBD therapeutics are not required for patients with stage I or II CKD. Depending on specific drug metabolism and renal excretion, dose adjustments may be required at more advanced-stage CKD,” the authors wrote.

SOURCE:

The study, led by Lynna Chen, Eastern Health Clinical School, Monash University in Melbourne, Australia, was published online in Alimentary Pharmacology & Therapeutics.

LIMITATIONS:

This review did not discuss limitations.

DISCLOSURES:

The authors received no specific funding for this work. Two authors disclosed receiving advisory fees and serving as speakers for various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.