April 7, 2020
What is the risk of infection in older IBD patients?
Both age and use of immunosuppressive medications are risk factors for infection in older IBD patients. Clinicians should take an individualized approach to balancing the risks and benefits of therapy.
Khan N, Vallarino C, Lissoos T, et al. Risk of Infection and Types of Infection Among Elderly Patients With Inflammatory Bowel Disease: A Retrospective Database Analysis. Inflamm Bowel Dis. 2020; 26(3):462–68; https://doi.org/10.1093/ibd/izz065
To document the risk of infection in IBD patients, including those 64 years of age or older, researchers retrospectively examined 63,759 records from the Truven Market Scan database, which includes commercial and Medicare claims from roughly 170 million people in the United States. All patients had initiated treatment with corticosteroids, immunomodulators, or biologic drugs during the study period between 2010 and 2014.
The authors found that 8,788 elderly with IBD experienced a total of 2,664 infections during the study period, translating to an incidence rate (IR) of 16.95 infections per 100 person-years. Among patients between 18–64 years of age, they found 10,515 experienced an infection, translating to an IR of 10.49 infections per 100 person-years. The IR of infections with hospitalization was 6.59 and 2.86 per 100 person-years for elderly and younger patients, respectively.
The most common infections in the elderly population were pneumonia (39.8%), sepsis (13.2%), candidiasis (12.9%) and herpes zoster (12.7%), while the most common infections among those 18–64 years of age were pneumonia (20.4%), candidiasis (30.2%), intestinal abscess (15.2%), herpes zoster (11.4%) and herpes simplex (10.4%).
Multivariate analyses controlling for a range of possible risk factors showed that older age was associated with a 27% higher risk of infections (Hazard Ratio [HR]: 1.27, P<0.0001). Other risk factors for infection among the entire IBD population included treatment with corticosteroids (HR: 1.4), anti-TNF agents (HR: 1.64), immunomodulator drugs (HR: 1.32), polypharmacy (HR: 1.32, P<0.0001), female sex (HR: 1.196) and a number of comorbid conditions, including chronic obstructive pulmonary disease (HR: 1.794), anemia (HR: 1.35), cancer (HR: 1.13), human immunodeficiency virus (HIV) (HR: 2.32), solid organ transplantation (HR: 1.82) and peripheral vascular disease (HR: 1.17) (all P<0.05).
Study Design: Retrospective cohort
Funding: Takeda Pharmaceuticals
Allocation: Not applicable
Setting: US commercial and Medicare claims database
Level of Evidence: 2b (Oxford Levels of Evidence)