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Elderly-onset IBD patients taking corticosteroids faced greater risk for serious infections
Rates of serious infection were greater in elderly-onset patients with inflammatory bowel disease taking oral corticosteroids than in matched controls, according to meta-analysis data.
Researchers identified 564 patients in Quebec province databases who were aged 66 years or older and diagnosed with IBD between January 1996 and December 2009. Each patient was matched with up to five controls by age, gender and year of cohort entry. Controls (n=2,646) showed no identifiable infections during 2.86 years of follow-up for both groups.
Case patients presented with significantly more hospital admissions, gastric and abdominal surgeries and physician visits within 1 year of index date. Comorbidities also were more prevalent among case patients, including diabetes, chronic respiratory diseases, chronic kidney diseases and cancer.
Patients exposed to oral corticosteroids in the 6 months before study inclusion had a greater risk for serious infection (adjusted RR=2.3; 95% CI, 1.8-2.9) compared with those who were corticosteroid naive. The most common serious infections included bronchopneumonia or pneumonia (34%), intestinal infections (25.6%), Clostridium difficile (12.1%) and fistulization and abscess formations (8%).
Current use of corticosteroids within 45 days also was associated with a greater risk for serious infections (adjusted RR=2.8; 95% CI, 2.1-3.7). Residual risk for serious infections was not significant after 90 days, while no risk differences were observed between ulcerative colitis or Crohn’s disease patients.
The researchers wrote that physicians should consider short-term corticosteroid therapy for elderly IBD patients.
“Overall, our findings suggest an excess risk for serious infections in elderly-onset IBD patients on oral corticosteroid therapy,” the researchers wrote. “A careful risk/benefit evaluation of corticosteroid use in elderly-onset IBD patients is warranted to fully inform clinical decision making.”
Disclosure: The researchers report no relevant financial disclosures.