Abstract
Biological therapy of inflammatory bowel disease (IBD) carries an increased risk for the development of opportunistic infections due to immunomodulation. The aim of this study was to determine the prevalence and types of oral infections in IBD patients treated with biological (anti-TNF-α and anti-integrin-α4β7) and conventional medication protocols. The study included 20 IBD patients receiving anti-TNF-α therapy, 20 IBD patients receiving anti-integrin-α4β7 therapy and 20 IBD patients without immunomodulatory therapy. Participants completed questionnaires on medical information, oral lesions and symptoms. For each patient, clinical examination and a salivary flow rate test were performed, followed by a swab of the oral mucosa. The swab samples were cultured to identify Candida spp. and oral bacteria. No bacterial opportunistic infections were detected. Candidiasis was detected in four participants, with no significant difference between groups (p = 0.765). Hyposalivation was most common in the anti-TNF-α group, with a significant difference between groups (p = 0.036). There were no significant differences between groups in self-reported oral mucosal lesions and symptoms (p > 0.05), or in the distribution of oral mucosal lesions (p > 0.05). This study suggests that IBD patients receiving biological therapy are at no greater risk of developing oral opportunistic infections than IBD patients not receiving immunomodulatory therapy.
Highlights
Over the past decade, the treatment of inflammatory bowel disease (IBD) has become increasingly dependent on immunomodulation, including biological therapy [1,2]
The exclusion criteria were ulcerative colitis (UC) and Crohn’s disease (CD) patients treated with other forms of biological therapy and immunosuppressive therapy (>20 mg prednisone, methotrexate and azathioprine), intermittent smokers, smoking fewer than five cigarettes per day, systemic or topical antifungal therapy, antibiotics used in the previous month and/or oral mouth rinses used in the previous month
No statistically significant differences were found between the groups in terms of sex, age, type of disease, C-reactive protein (CRP) levels, fecal calprotectin levels and duration of biological therapy (p > 0.05)
Summary
The treatment of inflammatory bowel disease (IBD) has become increasingly dependent on immunomodulation, including biological therapy [1,2]. Anti-tumor necrosis factor alpha (anti-TNF-α) agents were the first to be described and used as biologics for the treatment of IBD, but because of the complex pathophysiology of the disease, their efficacy has not been demonstrated in all patients [6]. The development of new non-TNF-α biologics with a different mechanism of action has helped to overcome the negatives. This group includes anti-integrins, anti-interleukin (IL) 12/23 and antiJanus kinase (JAK). Unlike other biologic therapeutics that have a systemic mechanism of action, anti-integrin-α4 β7 is considered to be gut-selective, meaning that its action is primarily limited to the site of inflammation in the gastrointestinal tract [9]
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