Ulcerative Colitis Resource Center

Ulcerative Colitis Resource Center

July 19, 2018
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IBD, steroid use increases influenza risk

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Patients with inflammatory bowel disease have a higher risk for influenza and are more likely to be hospitalized because of it, according to research published in Inflammatory Bowel Diseases.

Andrew Tinsley, MD, of the division of gastroenterology and hepatology at The Pennsylvania State University Hershey Medical Center, and colleagues wrote that their findings highlight the importance of vaccinating patients with IBD, particularly because immunization rates are generally low in that population.

“Misunderstanding about appropriateness and timing of various vaccinations, especially for those on immunosuppressive agents, appears to be high,” they wrote. “Rates of influenza vaccination in IBD patients have been shown to be very low, highlighting the need for improved efforts by gastrointestinal providers to ensure that patients are appropriately protected whenever possible.”

Researchers analyzed data from the MarketScan Database on 140,480 patients with and without IBD from 2008 to 2011. They compared incidence rates for influence between both groups and conducted a nested case-control study to assess any potential independent effect of IBD medications on influenza risk. The study included 68,586 patients with ulcerative colitis and 71,894 patients with Crohn’s disease. They noted that reliable information regarding vaccination status was not included in this data.

In the IBD population, Tinsley and colleagues identified 2,963 patients with influenza and determined an annual incidence rate of 709.5 per 100,000 per-years. There were 1,941 patients with influenza in the non-IBD population and an annual incidence rate of 459.7 per 100,00 person-years. Patients with CD had a higher annual incidence rate than patients with UC (766.2 vs 650.2 per 100,000 person-years).

Investigators determined that patients with IBD had an increased influenza risk compared with patients without IBD (incidence rate ratio = 1.54; 95% CI, 1.46–1.63), as well as a higher rate of hospitalizations (5.4% vs. 1.85%; P < .001).

In the nest case-control study, Tinsley and colleagues found that systemic corticosteroids were independently associated with influenza (OR = 1.22; 95%, 1.08–1.38). They did not find a similar association regarding other IBD therapies like biologics and immunomodulators, which they wrote was “surprising.”

“Our novel findings relating to influenza risk and severity in IBD patients will hopefully lead to further exploration of this important topic,” they wrote. “For now, it certainly arms the provider caring for IBD patients with important information on the potential risks and implications of becoming infected with this important pathogen. These results also stress the increased importance of vaccination against influenza (and other vaccine-preventable infections, including pneumococcal pneumonia) in IBD patients.” – by Alex Young

Disclosures: The authors report no relevant financial disclosures.