Serious Infections in Patients With Inflammatory Bowel Disease and Corticosteroids: A Propensity Score-Matched Study.

BACKGROUND & AIMS: Absolute risk estimates of serious infections in inflammatory bowel disease (IBD) across therapies and concomitant corticosteroid treatment are limited. We aimed to assess serious infection risk in patients with IBD receiving different therapies, with or without corticosteroids.

METHODS

Using nationwide Swedish registers (2007-2024), we compared rates of serious infections in patients with IBD treated with different therapies vs matched population comparators (≤10 per patient), stratified by corticosteroid use. We also performed 1:1 propensity score-matching for direct comparison of infection risk in IBD with or without concomitant corticosteroids exposure across advanced therapies. Incidence rates (IRs) and adjusted hazard ratios (aHRs) with 95% confidence intervals were calculated.

RESULTS

We identified 145,125 exposure periods in patients with IBD naïve to immunomodulators and advanced therapies, 82,675 to immunomodulators, and 90,181 to advanced therapies (tumor necrosis factor-α inhibitors with and without immunomodulator, anti-integrins, anti-interleukins, and Janus kinase inhibitors). Across therapies, exposure periods with corticosteroids carried a higher risk of serious infections than periods without, both compared with the general population (IR difference range, 3.6-10.2/100 person-years; aHR range, 4.52-15.86) and in propensity score-matched within therapy group comparisons (IR difference range, 3.9-8.5/100 person-years; aHR, 1.82-3.60). The relative risk was highest in children and increased with cumulative corticosteroid dose.

CONCLUSIONS

Patients with IBD receiving corticosteroids had significantly higher rates of serious infections compared with those not receiving corticosteroids across therapies, with rate differences across age groups and combinations of treatments. These data will inform infection risk assessment and consideration of individualized infection-prevention strategies.