Frailty linked with increased infection risk after immunosuppression for IBD
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Researchers found a link between frailty and risk for infection following immunosuppression in patients with inflammatory bowel disease after adjusting for age and comorbidities.
“Since infections and infection-related hospitalizations are a leading cause of morbidity and mortality in patients with IBD and a significant cause for concern among patients, frailty should be more systematically and prospectively studied in patients with IBD,” Bharati Kochar, MD, MSCR, of the division of Gastroenterology at Massachusetts General Hospital, and colleagues wrote. “Furthermore, interventions to improve frailty as well as multidisciplinary evaluation and care of patients who are frail may result in better outcomes for patients with IBD.”
Kochar and colleagues conducted a cohort study of 11,001 patients with IBD. They used a validated frailty definition based on the International Classification of Disease codes to identify frail patients vs. fit patients in the 2 years prior to initiation of anti-TNF or immunomodulator therapy. In total, 1,299 patients received an anti-TNF agent and 2,676 patients received an immunomodulator. Infection in the first year of treatment served as the primary outcome. Researchers used multivariable logistic regression models adjusted for clinically pertinent confounders to assess the correlation between frailty and post-treatment infections.
“The number of older patients with IBD is increasing,” Ashwin N. Ananthakrisnan, MD, MPH, of Massachusetts General Hospital Crohn’s and Colitis Center, and study co-author, told Healio Gastroenterology and Live Disease. “Rather than treating this group as a homogenous cohort above a certain age, it is important to stratify these patients further into those who may be older but fit and thus may be able to withstand risks of effective immunosuppressive therapy, and those who are frail who may merit a more cautious approach”.
In the 2 years prior to immunosuppression, 5% of patients in the anti-TNF therapy group and 7% of patients in the immunomodulator group were frail. Investigators noted these patients had more comorbidities and were older compared with fit patients. Study results showed higher proportions of frail patients compared with fit patients who developed infections after treatment (19% after anti-TNF and 17% after immunomodulators vs. 9% after anti-TNF and 7% after immunomodulators; P<.01 for frail vs. fit in both groups). After researchers adjusted for age, comorbidities and concomitant medications, they found frail patients had an increased risk for infection (anti-TNF adjusted OR, 2.05; 95% CI, 1.07–3.93 and immunomodulator aOR, 1.81; 95% CI, 1.22–2.7).
“There were too few infection-associated with hospitalizations in the anti-TNF group for robust statistical analysis,” Kochar and colleagues wrote. “However, frail patients with IBD were numerically more likely to have an infection-related hospitalization after anti-TNF patients compared with fit patients with IBD.”
Ananthakrisnan added that, “there is an important need to develop IBD-specific frailty scores that help us make this distinction more accurately and can guide our treatment.” – by Monica Jaramillo
Disclosure: Ananthakrisnan reports he receives research funding from Pfizer and the Scientific Advisory Board for Kyn Therapeutics. Kochar reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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