Infections Common in IBD, Rates Vary by Treatment

TOPLINE:

Patients with inflammatory bowel disease (IBD) experienced higher rates of mild and moderate infections. Women, smokers, those with multiple comorbidities, and those with exposure to certain IBD medications showed significantly higher rates of infections.

METHODOLOGY:

• Researchers conducted a prospective observational study (June 2020 to July 2021) to evaluate the incidence of and risk factors for mild, moderate, and severe infections in 629 patients (mean age, 48.3 years; 58.2% women) with IBD who used an established remote monitoring platform for IBD management.
• They used the Patient-Reported Infections Questionnaire, a validated seven-item tool with a 3-month recall period, to collect data on 15 infection categories, including respiratory tract, urinary tract, and skin conditions and COVID-19.
• The presence or absence of disease activity was confirmed using a combination of monitoring questionnaire scores for patient-reported disease activity and faecal calprotectin levels.
• The severity of infection was categorised on the basis of the type and route of treatment as mild (self-limiting or requiring topical treatment), moderate (requiring oral treatment), or severe (requiring hospitalisation and/or intravenous treatment).
• Exposure to different medications, alone or in combination, was also assessed.

TAKEAWAY:

• Overall, 991 infections were reported during 573.8 person-years of follow-up, with an overall incidence rate (IR) of 172.7 per 100 person-years, predominantly comprising mild (68%; IR, 117.5 per 100 person-years) and moderate (29.5%; IR, 50.9 per 100 person-years) infections.
• Women demonstrated significantly higher rates of infections than men (IR ratio [IRR], 1.70; P < .001), with increased rates of infections among current smokers vs non-smokers (IRR, 1.43; P = .004).
• Patients with a Charlson Comorbidity Index score > 2 had significantly higher rates of infections than those with lower scores (IRR for all infections, 1.69; P = .031).
• Glucocorticoid use more than doubled the rates of infections (IRR, 2.02; P = .033), and compared with no treatment, the use of JAK inhibitors, immunomodulator monotherapy, anti-TNF monotherapy, and combination therapy with anti-TNF and immunomodulators were associated with increased rates of infections.

IN PRACTICE:

“Clinicians should adopt a holistic approach that includes vigilant monitoring, preferably using validated tools, such as the PRIQ [Patient-Reported Infections Questionnaire], to identify patients with frequent mild or moderate infections. In addition, proactive application of preventive strategies, like vaccination, optimizing nutritional status, counselling for lifestyle modifications, and careful selection of therapies, should be used to reduce infection risk,” the authors of the study wrote.

SOURCE:

This study was led by Ashkan Rezazadeh Ardabili, MD, Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, the Netherlands. It was published online on July 09, 2025, in the Journal of Crohn’s and Colitis.

LIMITATIONS:

The study’s 1‐year follow‐up coincided with COVID‐19 public health measures, likely underestimating overall rates of infections. This study was underpowered to precisely assess rare outcomes, and its real‐world design limited the control over the distribution of medication groups, especially when stratifying the analysis by IBD subtype.

DISCLOSURES:

This study was supported in part by an investigator-initiated research grant from Takeda. Some authors reported receiving grants, non-financial support, and research prizes and serving as speaker, advisor, and/or principal investigator for various institutions and pharmaceutical companies, including Takeda.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.