Risk for fungal infections doubles with corticosteroid use vs. TNF-a inhibitors in IBD
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SAN DIEGO — Corticosteroid use should be minimized in patients with inflammatory bowel disease to reduce the risk for invasive fungal infections, according to research presented at Digestive Disease Week 2022.
“We know that the immunosuppressants used to treat IBD increase the risk for infection and multiple studies have shown that corticosteroids are by far the worst agents,” Martin H. Gregory, MD, of the division of gastroenterology at Washington University School of Medicine in St. Louis, said. “There hasn't been a large scale, systematic study to see what risk factors, such as corticosteroid use, are associated with the risk for invasive fungal infections.”
In a retrospective cohort study from 2006 to 2018, Gregory and colleagues analyzed 507,121 patients with IBD (54% Crohn’s disease; 44.7% ulcerative colitis) to determine the incidence of fungal infections as well as the association of IBD medications, mainly corticosteroids and tumor necrosis factor-alpha inhibitors (TNFi), with these infections. The incidence of tuberculosis infections was a secondary outcome.
Researchers identified invasive fungal infections in 3,899 patients at a rate of 281 cases per 100,000 patient-years (95% CI, 272-290). The most common fungal infection was candidiasis (243 cases/100,000 patient-years) followed by histoplasmosis (13.7 cases/100,000 patient-years). Compared with the rate of TB (25 cases/100,000 patient-years; 95% CI, 23-29), incidence of fungal infections among IBD patients was 11-fold higher.
Both corticosteroid use (HR = 3.9; 95% CI, 3.6-4.1) and TNFi use (HR = 2; 95% CI, 1.8-2.2) correlated with an increased risk for invasive fungal infections. According to Gregory, anemia, diabetes, central line and severe IBD also associated with increased risk.
“Invasive fungal infections are much more common than TB,” Gregory concluded. “Anti-TNFs do increase the risk of invasive fungal infection in IBD patients, but to a much lesser extent than corticosteroids.”
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Gregory MH, et al. Abstract 18. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
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