Patients treated with olmesartan may be at increased risk for enteropathy compared to those treated with other angiotensin II receptor blockers (ARBs), according to a study published in Alimentary Pharmacology and Therapeutics.

Few studies have investigated the association between olmesartan and sprue-like enteropathy, with results being largely inconsistent. To get a better understanding of whether the rate of enteropathy is higher with olmesartan compared to other ARBs, researchers conducted a cohort study among ARB initiators using 5 U.S. claims databases. They used Cox regression models to estimate hazard ratios (HR) for enteropathy-related outcomes (eg, celiac disease, malabsorption, diarrhea + weight loss, non-infectious enteropathy).

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After propensity score matching, the HRs comparing olmesartan to other ARBs were 1.21 (95% CI, 1.05-1.40) for celiac disease, 1.00 (95% CI, 0.88-1.13) for malabsorption, 1.22 (95% CI, 1.10-1.36) for diarrhea + weight loss, and 1.04 (95% CI, 1.01-1.07) for non-infectious enteropathy. HRs were larger for patients ≥65 years old, patients on treatment for >1 year, and those receiving higher cumulative doses of olmesartan.

The authors note that while the evidence points to a higher rate of enteropathy outcomes in patients treated with olmesartan, the absolute rate was found to be low. However, they conclude that “until more evidence is available, clinicians should consider olmesartan as a potential cause when evaluating patients with enteropathy and should consider alternative ARBs for these patients.”

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