Risk of Infection and Types of Infection Among Elderly Patients With Inflammatory Bowel Disease: A Retrospective Database Analysis

Abstract

Background Inflammatory bowel disease (IBD) treatment in the elderly is challenging in part because of increased risk of infections. The aim of our study was to determine the absolute and relative risk of infections among the elderly IBD patient population and to identify factors affecting the risk of infections in the overall IBD patient population. Methods A retrospective study of patients with IBD initiating corticosteroids, immunomodulators (IM), or biologic therapy (January 2010–December 2014) was conducted using the Truven Market Scan database. IM and biologic exposure were assessed in a time-dependent manner. ICD-9 codes identified infection during follow-up. A Cox proportional hazards model was fitted to gauge the association between age, other covariates, and infection risk. Results We identified 63,759 patients with IBD. We found 2664 infections (incidence rate [IR] = 16.95/100 person-years) among 8788 elderly patients with IBD and 10,515 (IR = 10.49/100 person-years) among the nonelderly group. Pneumonia (39.8%), sepsis (13.2%), and candidiasis (12.9%) were the most common infections in the elderly. Factors associated with a higher risk of infection included being elderly (HR: 1.27, P < 0.0001), anti-TNF therapy (HR: 1.64, P < 0.0001), IM therapy (HR: 1.32, P < 0.0001), and polypharmacy (HR: 1.32, P < 0.0001). Conclusions Advanced age, anti-TNF (biologic) therapy, and IM therapy were associated with an increased risk of infection. Pneumonia was the most common infection among the elderly IBD population. Physicians should be mindful of these risks when prescribing medications for elderly patients with IBD, and ensure their patients are adequately vaccinated.

Comorbidity, not patient age, is associated with impaired safety outcomes in vedolizumab‐ and ustekinumab‐treated patients with inflammatory bowel disease—a prospective multicentre cohort study

“…The prevalence of comorbidities found in our prospective cohort is comparable to a retrospective study by Khan et al in which 63.759 IBD patients who initiated corticosteroids, immunomodulators or biologic therapy were analysed. In this study, 25.7% of the overall cohort had one or more comorbidities according to the CCI 22 . However, other studies using the same CCI have shown a wide range of comorbidity prevalence.…”

Systematic review with meta‐analysis: biologics and risk of infection or cancer in elderly patients with inflammatory bowel disease

“…Several observational studies, and a meta‐analysis, have compared the risk in elderly IBD patients exposed to biologics with the risk in younger IBD patients exposed to such drugs, publishing highly significant results . However, these studies do not answer the most meaningful question (ie what are the risks of biologic therapies in elderly IBD patients as compared to administering other nonbiologic treatments).…”

“…Observational studies, on the other hand, lack the experimental design involving random allocation to optimally test exposure‐outcomes hypotheses, making it difficult to interpret the findings. Some studies have estimated the risk of infections and malignancies in elderly people with IBD exposed to biologic agents by using not clinically meaningful comparison groups (eg younger exposed patients), providing estimates that could be misinterpreted by clinicians . A recent meta‐analysis on the topic included only six studies of elderly patients treated with biologics compared with those unexposed .…”

COVID-19 in IBD: The experience of a single tertiary IBD center

“…Disease activity is a significant non-pharmacological risk factor for infections, therefore medical treatment aiming for disease control should be optimized [12] . On the other hand, IBD treatments include corticosteroids, immunosuppressants (such as thiopurines) and immunomodulators (such as TNF-antagonists, non-TNFtargeted biologics and targeted small molecule therapies), which may weaken the immune system and potentially place IBD patients at increased risk of infections and infectious complications [13] .…”