Risk of common infections in people with inflammatory bowel disease in primary care: a population-based cohort study

ObjectiveTo evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn’s disease] compared with matched controls in a contemporary UK primary care population.DesignMatched cohort analysis (2014–2019) using the Royal College of General Pr...

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Published inBMJ open gastroenterology Vol. 8; no. 1; p. e000573
Main Authors Irving, Peter M, de Lusignan, Simon, Tang, Daniel, Nijher, Monica, Barrett, Kevin
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group Ltd 17.02.2021
BMJ Publishing Group LTD
BMJ Publishing Group
Subjects
Chronic illnesses
Chronic obstructive pulmonary disease
Codes
Cohort analysis
Comorbidity
Coronaviruses
COVID-19
Crohn's disease
Epidemiology
Herpes viruses
Infections
Infectious diseases
Inflammatory bowel disease
Laboratories
Neutropenia
Pandemics
Pneumonia
Population
Population-based studies
Primary care
Surveillance
ulcerative colitis
Viral infections
United Kingdom > UK
primary care
Crohn's disease
ulcerative colitis
inflammatory bowel disease
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Abstract ObjectiveTo evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn’s disease] compared with matched controls in a contemporary UK primary care population.DesignMatched cohort analysis (2014–2019) using the Royal College of General Practitioners Research and Surveillance Centre primary care database. Risk of common infections, viral infections and gastrointestinal infections (including a subset of culture-confirmed infections), and predictors of common infections, were evaluated using multivariable Cox proportional hazards models.Results18 829 people with IBD were matched to 73 316 controls. People with IBD were more likely to present to primary care with a common infection over the study period (46% vs 37% of controls). Risks of common infections, viral infections and gastrointestinal infections (including stool culture-confirmed infections) were increased for people with ulcerative colitis and Crohn’s disease compared with matched controls (HR range 1.12–1.83, all p<0.001). Treatment with oral glucocorticoid therapy, immunotherapies and biologic therapy, but not with aminosalicylates, was associated with increased infection risk in people with IBD. Despite mild lymphopenia and neutropenia being more common in people with IBD (18.4% and 1.9%, respectively) than in controls (6.5% and 1.5%, respectively), these factors were not associated with significantly increased infection risk in people with IBD.ConclusionPeople with IBD are more likely to present with a wide range of common infections. Health professionals and people with IBD should remain vigilant for infections, particularly when using systemic corticosteroids, immunotherapies or biologic agents.Trial registration numberClinicaltrials.gov (NCT03836612).
AbstractList ObjectiveTo evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn’s disease] compared with matched controls in a contemporary UK primary care population.DesignMatched cohort analysis (2014–2019) using the Royal College of General Practitioners Research and Surveillance Centre primary care database. Risk of common infections, viral infections and gastrointestinal infections (including a subset of culture-confirmed infections), and predictors of common infections, were evaluated using multivariable Cox proportional hazards models.Results18 829 people with IBD were matched to 73 316 controls. People with IBD were more likely to present to primary care with a common infection over the study period (46% vs 37% of controls). Risks of common infections, viral infections and gastrointestinal infections (including stool culture-confirmed infections) were increased for people with ulcerative colitis and Crohn’s disease compared with matched controls (HR range 1.12–1.83, all p<0.001). Treatment with oral glucocorticoid therapy, immunotherapies and biologic therapy, but not with aminosalicylates, was associated with increased infection risk in people with IBD. Despite mild lymphopenia and neutropenia being more common in people with IBD (18.4% and 1.9%, respectively) than in controls (6.5% and 1.5%, respectively), these factors were not associated with significantly increased infection risk in people with IBD.ConclusionPeople with IBD are more likely to present with a wide range of common infections. Health professionals and people with IBD should remain vigilant for infections, particularly when using systemic corticosteroids, immunotherapies or biologic agents.Trial registration numberClinicaltrials.gov (NCT03836612).
ObjectiveTo evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn’s disease] compared with matched controls in a contemporary UK primary care population.DesignMatched cohort analysis (2014–2019) using the Royal College of General Practitioners Research and Surveillance Centre primary care database. Risk of common infections, viral infections and gastrointestinal infections (including a subset of culture-confirmed infections), and predictors of common infections, were evaluated using multivariable Cox proportional hazards models.Results18 829 people with IBD were matched to 73 316 controls. People with IBD were more likely to present to primary care with a common infection over the study period (46% vs 37% of controls). Risks of common infections, viral infections and gastrointestinal infections (including stool culture-confirmed infections) were increased for people with ulcerative colitis and Crohn’s disease compared with matched controls (HR range 1.12–1.83, all p<0.001). Treatment with oral glucocorticoid therapy, immunotherapies and biologic therapy, but not with aminosalicylates, was associated with increased infection risk in people with IBD. Despite mild lymphopenia and neutropenia being more common in people with IBD (18.4% and 1.9%, respectively) than in controls (6.5% and 1.5%, respectively), these factors were not associated with significantly increased infection risk in people with IBD.ConclusionPeople with IBD are more likely to present with a wide range of common infections. Health professionals and people with IBD should remain vigilant for infections, particularly when using systemic corticosteroids, immunotherapies or biologic agents.Trial registration numberClinicaltrials.gov (NCT03835780).
Objective To evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn’s disease] compared with matched controls in a contemporary UK primary care population.Design Matched cohort analysis (2014–2019) using the Royal College of General Practitioners Research and Surveillance Centre primary care database. Risk of common infections, viral infections and gastrointestinal infections (including a subset of culture-confirmed infections), and predictors of common infections, were evaluated using multivariable Cox proportional hazards models.Results 18 829 people with IBD were matched to 73 316 controls. People with IBD were more likely to present to primary care with a common infection over the study period (46% vs 37% of controls). Risks of common infections, viral infections and gastrointestinal infections (including stool culture-confirmed infections) were increased for people with ulcerative colitis and Crohn’s disease compared with matched controls (HR range 1.12–1.83, all p<0.001). Treatment with oral glucocorticoid therapy, immunotherapies and biologic therapy, but not with aminosalicylates, was associated with increased infection risk in people with IBD. Despite mild lymphopenia and neutropenia being more common in people with IBD (18.4% and 1.9%, respectively) than in controls (6.5% and 1.5%, respectively), these factors were not associated with significantly increased infection risk in people with IBD.Conclusion People with IBD are more likely to present with a wide range of common infections. Health professionals and people with IBD should remain vigilant for infections, particularly when using systemic corticosteroids, immunotherapies or biologic agents.Trial registration number Clinicaltrials.gov (NCT03835780).
Objective To evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn’s disease] compared with matched controls in a contemporary UK primary care population. Design Matched cohort analysis (2014–2019) using the Royal College of General Practitioners Research and Surveillance Centre primary care database. Risk of common infections, viral infections and gastrointestinal infections (including a subset of culture-confirmed infections), and predictors of common infections, were evaluated using multivariable Cox proportional hazards models. Results 18 829 people with IBD were matched to 73 316 controls. People with IBD were more likely to present to primary care with a common infection over the study period (46% vs 37% of controls). Risks of common infections, viral infections and gastrointestinal infections (including stool culture-confirmed infections) were increased for people with ulcerative colitis and Crohn’s disease compared with matched controls (HR range 1.12–1.83, all p<0.001). Treatment with oral glucocorticoid therapy, immunotherapies and biologic therapy, but not with aminosalicylates, was associated with increased infection risk in people with IBD. Despite mild lymphopenia and neutropenia being more common in people with IBD (18.4% and 1.9%, respectively) than in controls (6.5% and 1.5%, respectively), these factors were not associated with significantly increased infection risk in people with IBD. Conclusion People with IBD are more likely to present with a wide range of common infections. Health professionals and people with IBD should remain vigilant for infections, particularly when using systemic corticosteroids, immunotherapies or biologic agents. Trial registration number Clinicaltrials.gov ( NCT03836612 ).
To evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn's disease] compared with matched controls in a contemporary UK primary care population. Matched cohort analysis (2014-2019) using the Royal College of General Practitioners Research and Surveillance Centre primary care database. Risk of common infections, viral infections and gastrointestinal infections (including a subset of culture-confirmed infections), and predictors of common infections, were evaluated using multivariable Cox proportional hazards models. 18 829 people with IBD were matched to 73 316 controls. People with IBD were more likely to present to primary care with a common infection over the study period (46% vs 37% of controls). Risks of common infections, viral infections and gastrointestinal infections (including stool culture-confirmed infections) were increased for people with ulcerative colitis and Crohn's disease compared with matched controls (HR range 1.12-1.83, all p<0.001). Treatment with oral glucocorticoid therapy, immunotherapies and biologic therapy, but not with aminosalicylates, was associated with increased infection risk in people with IBD. Despite mild lymphopenia and neutropenia being more common in people with IBD (18.4% and 1.9%, respectively) than in controls (6.5% and 1.5%, respectively), these factors were not associated with significantly increased infection risk in people with IBD. People with IBD are more likely to present with a wide range of common infections. Health professionals and people with IBD should remain vigilant for infections, particularly when using systemic corticosteroids, immunotherapies or biologic agents. Clinicaltrials.gov (NCT03835780).
Author de Lusignan, Simon
Tang, Daniel
Nijher, Monica
Irving, Peter M
Barrett, Kevin
AuthorAffiliation 2 School of Immunology and Microbial Sciences , King's College London , London , UK
6 New Road Surgery , Croxley Green , Hertfordshire , UK
5 Pfizer Ltd , Tadworth , UK
4 Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) , London , UK
3 Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford , UK
1 Department of Gastroenterology , Guy's & St Thomas' Hospital , London , UK
AuthorAffiliation_xml – name: 1 Department of Gastroenterology , Guy's & St Thomas' Hospital , London , UK
– name: 3 Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford , UK
– name: 2 School of Immunology and Microbial Sciences , King's College London , London , UK
– name: 4 Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) , London , UK
– name: 5 Pfizer Ltd , Tadworth , UK
– name: 6 New Road Surgery , Croxley Green , Hertfordshire , UK
Author_xml – sequence: 1
  givenname: Peter M
  orcidid: 0000-0003-0972-8148
  surname: Irving
  fullname: Irving, Peter M
  email: peter.irving@gstt.nhs.uk
  organization: School of Immunology and Microbial Sciences, King's College London, London, UK
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  fullname: Tang, Daniel
  organization: Pfizer Ltd, Tadworth, UK
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  fullname: Nijher, Monica
  organization: Pfizer Ltd, Tadworth, UK
– sequence: 5
  givenname: Kevin
  surname: Barrett
  fullname: Barrett, Kevin
  organization: New Road Surgery, Croxley Green, Hertfordshire, UK
BackLink https://www.ncbi.nlm.nih.gov/pubmed/33597152$$D View this record in MEDLINE/PubMed
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Issue 1
Keywords primary care
Crohn's disease
ulcerative colitis
inflammatory bowel disease
Language English
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Tippu (2024051413253676000_8.1.e000573.32) 2017; 23
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Winthrop (2024051413253676000_8.1.e000573.58) 2018; 24
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2024051413253676000_8.1.e000573.26
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2024051413253676000_8.1.e000573.22
Neurath (2024051413253676000_8.1.e000573.5) 2019; 20
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Colombel (2024051413253676000_8.1.e000573.57) 2018; 24
Kucharzik (2024051413253676000_8.1.e000573.6) 2014; 30
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2024051413253676000_8.1.e000573.36
Irving (2024051413253676000_8.1.e000573.16) 2020
2024051413253676000_8.1.e000573.38
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Singh (2024051413253676000_8.1.e000573.42) 2017; 153
Brassard (2024051413253676000_8.1.e000573.10) 2014; 109
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Hanada (2024051413253676000_8.1.e000573.45) 2018; 16
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de Lusignan (2024051413253676000_8.1.e000573.20) 2006; 14
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2024051413253676000_8.1.e000573.43
2024051413253676000_8.1.e000573.46
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Snippet ObjectiveTo evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn’s disease] compared with...
To evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn's disease] compared with matched...
Objective To evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn’s disease] compared with...
OBJECTIVETo evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn's disease] compared with...
Objective To evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn’s disease] compared with...
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StartPage e000573
SubjectTerms Chronic illnesses
Chronic obstructive pulmonary disease
Codes
Cohort analysis
Comorbidity
Coronaviruses
COVID-19
Crohn's disease
Epidemiology
Herpes viruses
Infections
Infectious diseases
Inflammatory bowel disease
Laboratories
Neutropenia
Pandemics
Pneumonia
Population
Population-based studies
Primary care
Surveillance
ulcerative colitis
Viral infections
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Title Risk of common infections in people with inflammatory bowel disease in primary care: a population-based cohort study
URI http://dx.doi.org/10.1136/bmjgast-2020-000573
https://www.ncbi.nlm.nih.gov/pubmed/33597152
https://www.proquest.com/docview/2490441688/abstract/
https://www.proquest.com/docview/2589008709/abstract/
https://search.proquest.com/docview/2491072832
https://pubmed.ncbi.nlm.nih.gov/PMC7893652
https://doaj.org/article/ca1bf32f63774760a1aa776df45c2ac8
Volume 8
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