Issue 11

Clinical Question

For elderly IBD patients (aged >66 years), what are the infection risks associated with corticosteroid treatment?

Editor’s Bottom Line

Corticosteroid use in patients with elderly onset IBD is associated with higher risk of serious infection requiring hospitalization.

Reference

Brassard P, Bitton A, Suissa A, et al. Oral corticosteroids and the risk of serious infections in patients with elderly-onset inflammatory bowel diseases. Am J Gastroenterol. 2014 Nov;109(11):1795–802.
https://www.ncbi.nlm.nih.gov/pubmed/25267328

Synopsis

Incident cases of IBD in patients aged 66 years and older were identified using the databases of the Régie de l’assurance maladie du Québec (RAMQ) for the period of 1996–2009. Medication use and admission information to acute care hospitals were retrieved for each incident case. A “serious infection” was defined as a primary discharge diagnosis of infection according to the ICD codes for infection. Each case patient with a serious infection was matched with up to 5 IBD controls from the cohort and matched according to gender, age, and year of cohort entry. Corticosteroid users were identified by a prescription for any oral corticosteroid.

The IBD study cohort was comprised of 564 cases of serious infection matched to 2,646 controls. The mean follow-up of cases and controls was 2.86 years. Cases had significantly more hospital admissions, GI surgery, and physician visits preceding their date of serious infection compared to controls; cases also had a higher rate of comorbid conditions. Serious infection rates in IBD patients using corticosteroids any time during the previous 6 months were significantly higher than in non-users (aRR 2.3: 95% CI: 1.8-2.9). The risk of serious infection was highest in those exposed to corticosteroids within 45 days (aRR 2.8). The type of IBD was not an independent predictor of serious infection.

Details

Study Design: Nested case-control cohort
Funding: McGill University Health Centre
Allocation: Serious infection requiring hospitalization (case)
Setting: Health care databases for the province of Quebec
Level of Evidence: 1b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.