Corticosteroids Increase the Risk of Invasive Fungal Infections More Than Tumor Necrosis Factor-Alpha Inhibitors in Patients With Inflammatory Bowel Disease.
Crohn’s disease
candidiasis
histoplasmosis
immune suppression
ulcerative colitis
Journal
Crohn's & colitis 360
ISSN: 2631-827X
Titre abrégé: Crohns Colitis 360
Pays: England
ID NLM: 101752188
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
received:
14
11
2022
entrez:
13
3
2023
pubmed:
14
3
2023
medline:
14
3
2023
Statut:
epublish
Résumé
Invasive fungal infections are a devastating complication of inflammatory bowel disease (IBD) treatment. We aimed to determine the incidence of fungal infections in IBD patients and examine the risk with tumor necrosis factor-alpha inhibitors (anti-TNF) compared with corticosteroids. In a retrospective cohort study using the IBM MarketScan Commercial Database we identified US patients with IBD and at least 6 months enrollment from 2006 to 2018. The primary outcome was a composite of invasive fungal infections, identified by ICD-9/10-CM codes plus antifungal treatment. Tuberculosis (TB) infections were a secondary outcome, with infections presented as cases/100 000 person-years (PY). A proportional hazards model was used to determine the association of IBD medications (as time-dependent variables) and invasive fungal infections, controlling for comorbidities and IBD severity. Among 652 920 patients with IBD, the rate of invasive fungal infections was 47.9 cases per 100 000 PY (95% CI 44.7-51.4), which was more than double the TB rate (22 cases [CI 20-24], per 100 000 PY). Histoplasmosis was the most common invasive fungal infection (12.0 cases [CI 10.4-13.8] per 100 000 PY). After controlling for comorbidities and IBD severity, corticosteroids (hazard ratio [HR] 5.4; CI 4.6-6.2) and anti-TNFs (HR 1.6; CI 1.3-2.1) were associated with invasive fungal infections. Invasive fungal infections are more common than TB in patients with IBD. The risk of invasive fungal infections with corticosteroids is more than double that of anti-TNFs. Minimizing corticosteroid use in IBD patients may decrease the risk of fungal infections.
Sections du résumé
Background
UNASSIGNED
Invasive fungal infections are a devastating complication of inflammatory bowel disease (IBD) treatment. We aimed to determine the incidence of fungal infections in IBD patients and examine the risk with tumor necrosis factor-alpha inhibitors (anti-TNF) compared with corticosteroids.
Methods
UNASSIGNED
In a retrospective cohort study using the IBM MarketScan Commercial Database we identified US patients with IBD and at least 6 months enrollment from 2006 to 2018. The primary outcome was a composite of invasive fungal infections, identified by ICD-9/10-CM codes plus antifungal treatment. Tuberculosis (TB) infections were a secondary outcome, with infections presented as cases/100 000 person-years (PY). A proportional hazards model was used to determine the association of IBD medications (as time-dependent variables) and invasive fungal infections, controlling for comorbidities and IBD severity.
Results
UNASSIGNED
Among 652 920 patients with IBD, the rate of invasive fungal infections was 47.9 cases per 100 000 PY (95% CI 44.7-51.4), which was more than double the TB rate (22 cases [CI 20-24], per 100 000 PY). Histoplasmosis was the most common invasive fungal infection (12.0 cases [CI 10.4-13.8] per 100 000 PY). After controlling for comorbidities and IBD severity, corticosteroids (hazard ratio [HR] 5.4; CI 4.6-6.2) and anti-TNFs (HR 1.6; CI 1.3-2.1) were associated with invasive fungal infections.
Conclusions
UNASSIGNED
Invasive fungal infections are more common than TB in patients with IBD. The risk of invasive fungal infections with corticosteroids is more than double that of anti-TNFs. Minimizing corticosteroid use in IBD patients may decrease the risk of fungal infections.
Identifiants
pubmed: 36911593
doi: 10.1093/crocol/otad010
pii: otad010
pmc: PMC9999356
doi:
Types de publication
Journal Article
Langues
eng
Pagination
otad010Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn's & Colitis Foundation.
Références
Am J Gastroenterol. 2012 Sep;107(9):1409-22
pubmed: 22890223
BMJ. 2017 Apr 12;357:j1415
pubmed: 28404617
Ann Rheum Dis. 2014 Nov;73(11):1942-8
pubmed: 23852763
Clin Infect Dis. 2004 May 1;38(9):1261-5
pubmed: 15127338
Clin Infect Dis. 2001 Jul 15;33(2):177-86
pubmed: 11418877
Ann Intern Med. 2020 Dec 1;173(11):870-878
pubmed: 32956604
Crohns Colitis 360. 2021 Jun 09;3(3):otab026
pubmed: 36776652
N Engl J Med. 2020 Dec 31;383(27):2652-2664
pubmed: 33382932
Lancet. 2018 Dec 23;390(10114):2769-2778
pubmed: 29050646
Inflamm Bowel Dis. 2017 Dec 19;24(1):217-226
pubmed: 29272482
Am J Gastroenterol. 2018 Apr;113(4):481-517
pubmed: 29610508
Arthritis Care Res (Hoboken). 2012 May;64(5):625-39
pubmed: 22473917
Inflamm Bowel Dis. 2021 Jul 27;27(8):1177-1183
pubmed: 33043982
Diabetes Care. 2018 Mar;41(3):513-521
pubmed: 29330152
Chest. 2022 Feb;161(2):345-355
pubmed: 34673022
Dig Dis Sci. 2014 Oct;59(10):2406-10
pubmed: 24817338
J Crohns Colitis. 2019 Feb 01;13(2):182-188
pubmed: 30256926
Ann Rheum Dis. 2011 Apr;70(4):616-23
pubmed: 21177290