Oral Corticosteroids and the Risk of Serious Infections in Patients With Elderly-Onset Inflammatory Bowel Diseases

Brassard, Paul; Bitton, Alain; Suissa, Alain; Sinyavskaya, Liliya; Patenaude, Valérie; Suissa, Samy

doi:10.1038/ajg.2014.313

Cited by 116 publications

(92 citation statements)

References 36 publications

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“…In the present patient series, CAP was performed in patients with moderate or severe UC that required hospitalization, and a high remission rate was achieved. In general, CAP has the advantage of causing only mild adverse effects . There were few adverse effects of CAP in either the present study's younger group or the elderly group, and all events were reversible.…”

Section: Discussionmentioning

confidence: 45%

Efficacy and safety of granulocyte adsorption apheresis in elderly patients with ulcerative colitis

Ito

Omori

Hanafusa

et al. 2018

J of Clinical Apheresis

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Section: Discussionmentioning

confidence: 45%

Efficacy and safety of granulocyte adsorption apheresis in elderly patients with ulcerative colitis

Ito

Omori

Hanafusa

et al. 2018

J of Clinical Apheresis

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“…It should be noted that steroids are not suitable for maintenance therapy but are highly effective in remission induction. In the real world, patients with steroid dependency are treated with steroids for an extended period, and the associated adverse reactions are a concern [25, 26]. …”

Section: Discussionmentioning

confidence: 99%

Impact of inflammatory bowel disease on Japanese patients’ quality of life: results of a patient questionnaire survey

Ueno

Nakayama²,

Hagiwara³

et al. 2016

J Gastroenterol

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BackgroundInflammatory bowel disease (IBD) has a significant negative impact on quality of life (QOL); however, the direct impact of IBD on several aspects of patients’ lives is unknown. The IMPACT survey was conducted in Europe in 2010–2011 to determine this impact. We conducted the IMPACT survey in Japan and compared the results between subgroups of patients with ulcerative colitis (UC) and Crohn’s disease (CD).MethodsThe 52-item IMPACT survey questionnaire assessing treatment and the impact of IBD on patients’ lives was translated into Japanese and administered to IBD patients recruited through patient advocacy groups.ResultsBetween June 2013 and January 2014, 172 Japanese IBD patients completed the questionnaire (including 84 UC and 83 CD patients). Half of all patients (84/172, 48.8 %) were satisfied with their treatment plan, and half of those who had undergone surgery were satisfied with the outcome (46/87, 52.9 %). Although 34.9 % (60/172) of patients had not been hospitalized in 5 years, 50.0 % (86/172) had been hospitalized for more than 10 days. During the most recent flare, 49.4 % (85/172) of patients had to reschedule appointments because of IBD. Moreover, 32.0 % (55/172) of patients had to make adjustments such as working part-time or at home to avoid taking sick days; 35.5 % (61/172) of patients felt that they had lost a job because of IBD.ConclusionsOur survey results indicate that IBD patients’ lives and social activities are affected by the deterioration of QOL due to IBD and its symptoms.Electronic supplementary materialThe online version of this article (doi:10.1007/s00535-016-1241-x) contains supplementary material, which is available to authorized users.

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“…Corticosteroid use is a marker of active intestinal inflammation, which predisposes to infection. To make a more direct association between corticosteroids and infection, the authors showed a time-dependent risk of serious infection, with more recent corticosteroid use associated with the highest vulnerability to infection [50]. In another study evaluating 100 consecutive IBD patients with opportunistic infections, increasing age was a risk factor for infection.…”

Section: Moderate-severe Diseasementioning

confidence: 96%

Challenges in the Diagnosis and Management of Inflammatory Bowel Disease in the Elderly

Taleban

2015

Curr Treat Options Gastro

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Among inflammatory bowel disease (IBD) patients, 4-12 % is diagnosed after the age of 60. Both the rates of elderly and IBD are increasing worldwide. In older patients, the diagnosis of Crohn's disease (CD) and ulcerative colitis (UC) is made more difficult due to polypharmacy and multimorbidity along with disease processes that mimic IBD. The clinical presentation in older-onset IBD differs from younger patients, and there is minimal disease progression over time. The management of the older IBD patient involves a combination of medical and surgical strategies. Few treatment efficacy studies exist in elderly IBD as most authors have focused on the adverse events related to therapy. A vast number of incident CD and UC cases in elderly have been treated with 5-aminosalicylic acid agents and do not require the use of immune modifying agents or biologics. Many other older IBD patients are prescribed long-term corticosteroids despite guidelines recommending more effective and safer maintenance therapy regimens. Serious infections, malignancy, and drug interactions are the most concerning complications of medical therapy. There are particularly important health care maintenance issues in older IBD patients including vaccinations, colorectal cancer screening, and bone loss prevention.

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Oral Corticosteroids and the Risk of Serious Infections in Patients With Elderly-Onset Inflammatory Bowel Diseases

Abstract: We found an excess relative risk for serious infections in elderly-onset IBD patients on oral corticosteroid therapy. Those with current exposure demonstrated a higher vulnerability to infections.

Cited by 116 publications

References 36 publications

Efficacy and safety of granulocyte adsorption apheresis in elderly patients with ulcerative colitis

Efficacy and safety of granulocyte adsorption apheresis in elderly patients with ulcerative colitis

Impact of inflammatory bowel disease on Japanese patients’ quality of life: results of a patient questionnaire survey

Challenges in the Diagnosis and Management of Inflammatory Bowel Disease in the Elderly

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