Dose-escalation in IBD after CDI does not increase adverse outcomes risk
ORLANDO — Initiating immunosuppressive medication following treatment for Clostridium difficile infection was not correlated with adverse clinical outcomes in patients with inflammatory bowel disease, according to a presenter here.
“Nearly 29,300 deaths are estimated from CDI annually in the United States,” Dana J. Lukin, MD, PhD, of Montefiore Medical Center, said during his presentation. “Rates of CDI and morbidity are significantly higher among patients with IBD when compared with those in the general population, with increased susceptibility to hypervirulent strains.”
For the multicenter, retrospective cohort IBD ReMEdY study, Lukin and colleagues aimed to assess the influence of dose-escalated immunosuppressive medication on outcomes after CDI in 207 patients (49 outpatient, 158 inpatient) with IBD treated across four academic medical centers in New York City.
The researchers assessed outcomes 30 and 90 days out from the most recent positive C. difficile test. They used two-sided T-tests to compare continuous variables; they compared proportions with Chi-squared tests.
Primary outcome was the impact of therapy escalation on 90-day clinical outcomes. Secondary outcomes included recurrence of infection, re-hospitalization and worsening of IBD.
Patients assigned IBD dose-escalation therapy within 90 days of CDI were less likely to experience severe outcomes (adjusted OR = 0.12). Escalation of an IBD regimen at 90 days was most frequent among outpatients vs. inpatients (43% vs. 22%; P < .01).
Rates of sepsis were higher among those not treated with a dose-escalated regimen (11% vs. 2%; P = .04). Compared with patients treated with a dose-escalated regimen, patients who were not on an escalated regimen had higher rates of death, sepsis or colectomy (2% vs. 15%; P < .01). There were no differences in CDI recurrence or rehospitalization rates between the two groups.
“These data suggest that escalation of IBD therapy following CDI is not associated with worse clinical outcomes and a subset of patients may benefit from timely treatment of underlying inflammatory disease,” Lukin said. “Prospective studies are required to determine the optimal timing of initiation of immunosuppressive therapy following CDI.” – Jennifer Southall
Lukin DJ, et al. Abstract 16. Presented at: World Congress of Gastroenterology at American College of Gastroenterology Annual Scientific Meeting; Oct. 13-18, 2017; Orlando, FL.
Disclosure : Lukin reports no relevant financial disclosures.