The November issue of the American Journal of Gastroenterology contains a paper which once again stresses the potential danger of immunosuppressant drugs in the treatment of IBD.
Steroid use predisposes to infections and this effect is greater in elderly patients. In this study from Canada, the Quebec province healthcare database was used to conduct an analysis of IBD patients older than 66yrs. More than 3500 patients were identified and no less than 1/5 th had serious infections during a 4 year follow-up. The most common serious infections were pneumonia (34.4%) and intestinal infections (25.6%) including c difficile entero colitis. Exposure to oral cortico steroids more than doubled the risk of infection and this effect continued for up to 180days after treatment, but was unsurprisingly greater in those currently taking corticosteroids. The authors emphasized that particular care and vigilance are needed when steroids are given to elderly patients with IBD.
The increase in infections in those given anti-TNF therapy did not reach significance, but the number of patients receiving these agents was very small (less than 1% of the total).
For those of us who promote the value of dietary therapy for CD, this data provides yet another argument for supporting its use as such side effects do not occur in patients treated that way. Sadly, Ulcerative colitis does not respond to diet!
This article was first published on the original crohns.org.uk blog. Research has moved on since, so please check current advice with your IBD team.