Infections in IBD patients on immunomodulators, corticosteroids, and anti-TNF therapy: Is elderly age a predictor?

Background: Inflammatory bowel disease (IBD) therapy, including immunomodulatory (IMM), corticosteroids (CS), and TNF inhibitors (TNFI), is known to increase the infectious risk when used in to treat many diseases. No recent studies have analyzed the incidence of infections in elderly patients on these therapies. We aim to analyze the effect of immunosuppressant use and age on infectious complications in IBD patients. Methods: A retrospective cohort study was conducted of patients at a tertiary care center with Crohns disease (CD), ulcerative colitis (UC), or IBD, comparing infection risk in patients ≥65 years old to those < 65 years old. Chi-square and Wilcoxon Rank Sum statistics were performed. Infection rate ratio (IRRs) were evaluated. Results: 292 patients were assessed. 83% of patients < 65years old and 72% of patients ≥65years old were on immunosuppressant’s. Infections occurred in 41.4% patients. 7.8% of the cohort had ≥2 infections. The infection incidence rate per year of follow up in the younger and older cohorts were 0.106 and 0.170, respectively, with IRR of 1.60 (95% CI=1.16, 2.21) in the older. The IRR in elderly patients on CS compared to non-CS regimens was 3.28 (95% CI=1.62, 6.64). The IRR in elderly patients on IMM and CS, and on TNFI and CS were 10.58 (95% CI=1.27, 87.91) and 10.64 (95% CI=1.95, 58.10), respectively. Conclusions: Increasing age is associated with an increased risk for infections in IBD patients using immunosuppressive medications. CS had the highest IRR for infections compared to other therapies. Infectious risk is greatly increased when CS are added to IMM and TNFI. Correspondence to: Christina Tofani, MD, 132 S. 10th St., Main Building, Suite 480, Philadelphia, PA, USA, Tel: +1 215-662-4000; E-mail: [email protected]