P0607 Opportunistic infections in patients with inflammatory bowel disease under advanced drug therapy. Real-word experience of 8 years from a medium-volume center in Cordoba, Argentina
Authors: Torello R , Salvatierra M , Balderramo D C 
Published: January 2025

Background

The frequency of inflammatory bowel disease (IBD) has been rising in Latin American countries. Opportunistic infections (OIs) are a potential complication in patients receiving advanced drug therapy (ADT), particularly when combined with corticosteroids and immunosuppressants. Our objective was to evaluate the frequency of OIs in patients with IBD undergoing ADT in a real-world setting.

Methods

An observational study was conducted using data from the registry (n=395) of a private center in Córdoba, Argentina. We included adult patients (pts) diagnosed with IBD [ulcerative colitis (UC) or Crohn’s disease (CD)] who had at least one prescribed ATD. We analyzed the presence of OI after starting ADT and the use of concomitant treatments (corticosteroids and immunosuppressants) during follow-up. Qualitative variables were described as percentages and quantitative variables were described as medians and interquartile ranges (IQR 25-75). Variables were compared using the chi-square and Mann-Whitney U tests.

Results

We included 118 pts (58.5% UC, 41.5% CD) who received 180 ATDs during follow-up (2017-2024). Median age was 44.5 years (IQR 25-75: 32-55.5), and 54.2% were female. A total of 24 (20.3%) pts presented OI during follow-up and 35 episodes of OI were observed out of 180 ADTs prescribed. Two patients (8.3%) presented a fatal outcome. OI episodes were skin and soft tissue infections (n=10, 28.6%), cytomegalovirus colitis (n=7, 20%), Clostridium difficile colitis (n=6, 17.1%), herpes zoster virus infection (n=3, 8.6%), complex herpes simplex infection (n=3, 8.6%), fungal infection (n=3, 8.6%), severe pneumonia (n=2, 5.7%), and intestinal tuberculosis (n=1, 2.9%). OI episodes distribution according to drug class was: Anti-TNF (n=21, 60%), anti-IL 12-23/IL-23 (n=9, 25.7%), vedolizumab (n=4, 11.4%), and JAK inhibitors (n=1, 2,9%). The proportion of OI episodes was similar according to the use of anti-TNF (19.8%) vs. non-anti-TNF drugs (17.7%), p=0.6. In 26 (74.3%) of the OI episodes patients were receiving corticosteroids simultaneously. The simultaneous use of corticosteroids was associated with a higher number (&gt;1 episodes) of OI episodes per patient (100% vs 50%, p=0.04). Within patients with concurrent corticosteroid use, there was a similar number of episodes if the ADT was anti-TNF compared to another class (50% vs. 67% respectively, p=0.7).

Conclusion

The concurrent use of corticosteroids was a risk factor for OI in patients with IBD receiving ATDs. No higher frequency of OIs was observed in patients receiving anti-TNF agents compared to those receiving ATDs of other classes. Further studies are needed to evaluate OIs in regions with limited access to ATDs.

References

Balderramo D, Quaresma AB, Olivera PA, Savio MC, Villamil MPG, Panaccione R, Ng SC, Kaplan GG, Kotze PG. Challenges in the diagnosis and treatment of inflammatory bowel disease in Latin America. Lancet Gastroenterol Hepatol. 2024 Mar;9(3):263-272. doi: 10.1016/S2468-1253(23)00284-4. PMID: 38340754.