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Age Tied to Infection Risk in IBD
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Elderly patients with inflammatory bowel disease have a higher risk for infection because of their age and other factors, according to study results.
Nabeel Khan, MD, of the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote that previous studies of infection have been limited in patients aged older than 65 years, but exploring the risk in this cohort is becoming more important as the population grows older and mortality rates decrease.
“There is wide variability in the utilization of medications that are used to treat elderly IBD patents in different parts of the world,” they wrote. “Evaluation of medication patterns among the elderly population in the USA have shown a high proportion of chronic steroid use with lower utilization of steroid-sparing regimens. This may be partly due to increased risk of infections among the elderly.”
Researchers analyzed data from the Truven Market Scan database to find patients with IBD who initiated corticosteroid, immunomodulator or biologic therapy between 2010 and 2014 (n = 63,759) and identify factors associated with infection risk.
Investigators found 2,664 infections among the 8,788 elderly patients with IBD (incidence rate = 16.95 per 100 person years; 95% CI, 16.32–17.61) compared with 10,525 infections among the non-elderly patients (IR = 10.49 per 100 person years; 95% CI, 10.29–10.69). Incidence of infection with hospitalization was also higher among the older patient group (IR = 6.59 per 100 person years; 95% CI, 6.22–6.98) compared with the other patients (IR = 2.86 per 100 person years; 95% CI, 2.76–2.96).
Among patients older than 65 years, the most common infections were pneumonia (39.8%), sepsis (13.2%), and candidiasis (12.9%).
Khan and colleagues found that being aged at least 65 years (HR = 1.27; 95% CI, 1.206–1.344), anti-TNF therapy (HR = 1.641; 95% CI, 1.277–1.63), immunomodulator use (HR = 1.321; 95% CI, 1.251–1.394) and polypharmacy (HR = 1.322; 95% CI, 1.271–1.375) were all associated with a higher risk for infection.
“Physicians need to be cognizant of these factors while starting patients on [immunomodulator] and biologic therapies, and they should ensure that their elderly patients are up to date with their immunizations,” they wrote. “Risks and benefits of treatment should be discussed with patients, and targeted IBD therapies with non-systemic [immunomodulator] mechanisms of action in elderly patients may be a therapeutic option for consideration.” – by Alex Young
Disclosures: Khan reports grant support from Luitpold Pharmaceuticals, Pfizer and Takeda. Please see the full study for all other authors’ relevant financial disclosures.
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