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Patients with IBD at increased risk for invasive pneumococcal disease
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Inflammatory bowel disease patients have an increased risk for invasive pneumococcal disease both before and after being diagnosed with either Crohn’s disease or ulcerative colitis, according to results from a Danish population-based cohort study.
“The inappropriate innate immune response against infective agents observed in patients with IBD is hypothesized to increase the risk of bacterial infections,” Bjørn Kantsø, MSc, from the department of microbiological diagnostics and virology at Statens Serum Institut in Copenhagen, Denmark, and colleagues wrote. “Also, treatment with immunomodulators has been suspected to increase the risk of bacterial infection in patients with IBD.”
Bjørn Kantsø
Kantsø and colleagues therefore aimed to determine the risk of invasive pneumococcal disease (IPD) in patients with IBD compared with the general population, how IBD medications may affect this risk and whether the risk varies before or after IBD diagnosis.
Using national registries, they identified 74,156 patients diagnosed with IBD between 1977 and 2013 (Crohn’s disease, 29.8%; UC, 70.2%) and 1,482,363 controls from the general population matched by age, gender and residence at the time of IBD diagnosis. IPD was diagnosed in 0.37% of IBD patients and 0.27% of controls during 824,784 person-years of follow-up.
IBD patients had a significantly higher risk for IPD compared with controls overall. Crohn’s disease patients had twice the risk compared with controls (HR = 1.99; 95% CI, 1.59-2.49), while UC patients were 1.5 times as likely to be diagnosed with IPD compared with controls (HR = 1.46; 95% CI, 1.25-1.69).
Within the first year after IBD diagnosis, Crohn’s disease patients had nearly three times the risk for IPD compared with controls (HR = 2.97; 95% CI, 1.86-4.76), which then fell 2 to 4 years after IBD diagnosis (HR = 2.15; 95% CI, 1.57-2.96). UC patients had twice the risk for IPD compared with controls within the first year after IBD diagnosis (HR = 2.15; 95% CI, 1.57-2.96), which also fell 2 to 4 years after IBD diagnosis (HR = 1.35; 95% CI, 1.11-1.63).
UC patients who were exposed to azathioprine had a higher risk for IPD compared with UC patients who were not (HR = 2.38; 95% CI, 1-5.67). Compared with controls, UC patients had a higher risk for IPD 0 to 1 years (OR = 3.3; 95% CI, 2.14-5.08) and 2 to 4 years (OR = 1.51; 95% CI, 1.05-2.17) before IBD diagnosis. Crohn’s disease patients also had a higher risk for IPD compared with controls 2 to 4 years before IBD diagnosis (OR = 1.79; 95% CI, 1.05-3.03).
“In conclusion, our nationwide study revealed an increased risk of IPD both prior to and after diagnosis of IBD,” the researchers wrote. “The post-IBD risk was most pronounced in the first years after diagnosis, but remained increased over time, especially in [Crohn’s disease]. IBD medications, including TNF-alpha antagonists, had little impact on risk, and our results suggest that general vulnerability around the time of diagnosis of IBD may contribute to the increased risk of IPD.”
“The finding in this study highlights the numerous recommendations on routine pneumococcal vaccination,” Kantsø told Healio Gastroenterology. “However, it is uncertain whether these recommendations are followed.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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