No Significant Increased Risk of Infection Found in Older Adults with IBD Taking Immunosuppressants

Advanced therapies play an important role in inducing and maintaining remission in patients with inflammatory bowel disease (IBD). Typically reserved for those with moderate-to-severe disease, the group includes immunomodulators, such as azathioprine; biologics, such as tumor necrosis factor (TNF) inhibitors; and small molecules, such as Janus kinase (JAK) inhibitors.

Although these agents come with many benefits, they have also been known to increase the risk of infection due to their immunosuppressive properties. Older adults with IBD, including Crohn’s disease and ulcerative colitis, may have comorbidities that may contribute to an increased risk of infection.

In a retrospective cohort study presented as a poster at Digestive Disease Week 2024, Arvin Daneshmand, M.D., internal medicine resident at the University of Florida in Gainesville, and his colleagues evaluated the risk of infection associated with advanced therapies in older adults with IBD.

The investigators used data from Medicare fee-for-service claims between 2012 and 2019. The study included 672 patients aged 65 years and older with an IBD diagnosis and newly prescribed advanced therapy propensity-matched with 672 participants who were initiated on a nonimmunosuppressive 5-aminosalicylic acid (5-ASA)-derived drug.

Patients were followed for one year or until an infection occurred, whichever came first. About 60% of the group were 65 to 74 years of age, 33% were 75 to 85 years, and 6.7% were 85 years and older. The most common comorbidities observed were hypertension (46%), hyperlipidemia (35%), and diabetes (17%). A majority (60%) of the group also took corticosteroids.

The analysis showed an incidence of infection of 14.5 per 100 person-years in the advanced therapy group versus 13.5 per 100 person-years in the 5-ASA group. These results corresponded with an adjusted hazard ratio of 1.01. The researchers concluded that, although initiating advanced therapies in older adults with IBD slightly increased the risk for infection, the difference was not statistically significant.