Infection Rates with Infliximab in Inflammatory Bowel Disease Compared to Rheumatologic Diseases: A Single Center Experience

Abstract

Purpose: Tumor necrosis factor-alpha (TNF-α) inhibitors have revolutionized the treatment of inflammatory bowel disease (IBD) and other rheumatologic diseases such as rheumatoid arthritis (RA) and psoriasis. There is a paucity of data directly comparing the therapy related complications between these two groups treated with infliximab at a single center. The aim of this study was to compare the infection rates between the two groups. Methods: We examined the medical records of all patients receiving infliximab from January 2003 to September 2010 at NorthShore University Health-System, which includes four community hospitals. Data on all patients that received at least one infliximab infusion were collected including age, sex, race, infections, serious infections, treatment with concomitant immunomodulators, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs) and narcotics. Serious infections were defined as those leading to or prolonging hospitalization, those that were fatal or life threatening or those that resulted in significant disability. Statistical significance was determined using Fisher's exact test, t-test or chi square test. Results: A total of 120 patients with IBD (85 with Crohn's disease and 35 with ulcerative colitis) and 77 patients with rheumatologic diseases (50 with RA and 27 with psoriatic arthritis) received infliximab infusions. The average age of the IBD cohort was 43.4 (18-91), while the average age of the rheumatologic diseases cohort was 62.5 (24-91); two-tailed p value <0.0001. Patients with rheumatologic diseases were more likely to be on concomitant immunomodulators when compared with IBD patients (73/77 vs. 58/120, p value <0.0001). Among the IBD patients 18/120 (15%) developed an infection vs. 22/77 (28.6%) of patients with rheumatologic diseases (p value 0.029). In the IBD group 11/18 (61.1%) were serious infections while 6/22 (27.2%) were observed in the rheumatologic group (p value 0.05). Patients with rheumatologic diseases were also more likely to use narcotic agents compared to IBD patients (44/77 vs. 47/120, p value 0.019). No difference in gender, sex, race, corticosteroid use, NSAID use, PPI use was found. Conclusion: Our study demonstrates a higher overall risk of development of infections with the use of infliximab in RA and psoriasis patients as compared with IBD patients but with a higher risk of serious infections in the IBD patient population. Older age, greater use of concomitant immunomodulators and narcotics agents among rheumatologic patients may be associated with this observation. Further research is needed to clarify the role of these differences on the clinical management of patients receiving TNF-α inhibitors.