Always keep in mind the drug-induced risk of infection with inflammatory bowel diseases
Video report presented by Dr. Eugeni Domènech, Badalona, Spain at the Symposium 206 “From the New and Complex Concepts to the Real Patient: Science and Clinic in IBD”, March 31 – April 1, 2017 in Madrid, Spain
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“From the New and Complex Concepts to the Real Patient: Science and Clinic in IBD” was the title of Symposium 206 organized by the Falk Foundation in March in Madrid. More than 1100 physicians from 49 nations obtained information on site about the latest findings with regard to diagnostics and therapy of inflammatory bowel diseases.
The lecture by Dr. Eugeni Domènech from Badalona received great interest. He spoke about the potential occurrence of infections in the therapy of inflammatory bowel diseases.
Patients with ulcerative colitis and Crohn’s disease have an increased risk of infection. It is increased by treatment with immunomodulatory drugs. These drugs can particularly facilitate the occurrence of tuberculosis, an infection with human papillomaviruses or a herpes simplex infection.
A distinction is to be made between general infections, serious infections and opportunistic infections when assessing the risk of infection.
There is a clearly increased risk of infection during therapy with systemic corticosteroids, with immunomodulators and with anti-TNF therapy strategies. The risk of infection is not increased through aminosalicylates and antibiotics, apart from the risk of infection with Clostridium difficile. Data with regard to this question is still missing up to now with locally acting corticosteroids.
In particular, the risk of infection under systemic corticosteroids is often underestimated. For Crohn’s disease it is approximately 25% and therefore higher than the likelihood of for example the occurrence of nausea and vomiting.
Serious infections are also more frequent under systemic corticosteroids. Controlled clinical trials substantiate this finding. This is to be particularly taken into consideration if other risk factors are present, such as higher age, malnutrition, diabetes mellitus or other relevant comorbidities.
Certain therapeutic agents for IBD can increase the risk of infection. This particularly applies to systemic corticosteroids and biologics. In addition to the general risk of infection, the risk of serious infections also increases significantly under therapy. Treatment with mesalazine as well as with antibiotics is unproblematic in this regard, apart from the risk of infection with Clostridium difficile.