Colon to Rectum
Inflamm Dis. 2023;29(3):339−48
The risk of serious infections before and after anti-TNF therapy in inflammatory bowel disease: A retrospective co-hort study
Background: Serious infections have been observed in patients with inflammatory bowel disease (IBD) on anti-tumor necrosis factor (TNF) use − but to what extent these infections are due to anti-TNF or the disease activity per se is hard to disentangle. Aim of the present study was to de-scribe how the rates of serious infections change over time both before and after starting anti-TNF in IBD.
Methods: IBD patients naive to anti-TNF treatment were identified at 5 centers participating in the Swedish IBD Quality Register, and their medical records were examined in detail. Serious infections, defined as infections requiring in-patient care, the year before and after the start of anti-TNF treatment were evaluated.
Results: Among 980 patients who started their first anti-TNF therapy between 1999 and 2016, the incidence rate of serious infections was 2.19 (95% confidence interval [CI]: 1.43−3.36) per 100 person years the year before and 2.11 (95% CI: 1.33−3.34) per 100 person years 1 year after treatment start. This corresponded to an incidence rate ratio 1 year after anti-TNF treatment of 0.97 (95% CI: 0.51−1.84). Compared with before anti-TNF therapy, the incidence of serious infection was significantly decreased more than 1 year after treatment (incidence rate ratio = 0.56; 95% CI: 0.33−0.95; p = 0.03).
Conclusions: In routine clinical practice in Sweden, the incidence rate of serious infection among inflammatory bowel disease patients did not increase with anti-tumor necrosis factor (TNF) therapy. Instead, serious infections seemed to decrease more than 1 year after initiation of an-ti-TNF treatment.
DOI: 10.1093/ibd/izac097