Relevant infections in inflammatory bowel disease, their relationship with immunosuppressive therapy and their effects on disease mortality.
J Crohns Colitis. 2019 Jan 18;:
Authors: Zabana Y, Rodríguez L, Lobatón T, Gordillo J, Montserrat A, Mena R, Beltrán B, Dotti M, Benitez O, Guardiola J, Domènech E, Garcia-Planella E, Calvet X, Piqueras M, Aceituno M, Fernández-Bañares F, Esteve M
INTRODUCTION: There is controversy as to whether the risk of relevant infection in IBD is related to immunosuppressants or the disease itself.
AIMS: To evaluate: 1) the life-long prevalence and types of relevant infections in patients with IBD related to immunosuppressive treatment, and 2) the relationship of both infection and patient comorbidity to mortality.
METHODS: Observational multicentre retrospective study of IBD patients that presented a relevant infection. For each case, four periods of infection exposure were analysed: P1: pre-IBD diagnosis, P2: from IBD diagnosis to immunosuppressant initiation, P3: during immunosuppressant therapy, and P4: after treatment withdrawal.
RESULTS: The life-long prevalence of relevant infection in the total cohort of patients (6,914) was 3%, and 5% in immunosuppressed patients (4,202). 366 relevant infections were found in 212 patients (P1: 9, P2: 17, P3: 334, and P4: 6). Differences between periods were significant (p< 0.0001). The most frequent types of infection were respiratory, intestinal and urinary. The most frequent opportunistic infections were tuberculosis (prevalence: 2.6/1000) and herpes zoster (prevalence: 3.9/1000). Herpes zoster infection was associated with thiopurines alone or in combination with anti-TNF in 75% of the cases, whereas tuberculosis was associated with anti-TNF in 94% of patients. The overall mortality was 4.2%. Infection-related mortality was 2.8% and it was not influenced by comorbidity.
CONCLUSIONS: Relevant infections in IBD patients are rare and appear to be related to immunosuppression. Relevant infection is a major cause of death in IBD.
PMID: 30668662 [PubMed – as supplied by publisher]