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P224. Anti TNF-alpha therapy and steroids increase the risk of opportunistic infection in patients with inflammatory bowel disease


C. Glen1, I. Arnott2, J. Satsangi2

1University of Edinburgh, Edinburgh, United Kingdom; 2Western General Hospital, GI Unit, Edinburgh, United Kingdom



Background: Over the past decade the management of inflammatory bowel disease has been revolutionised by the use of anti-TNF α agents. However a concern remains over patient safety. Previous research has yielded conflicting results regarding the frequency and severity of opportunistic infections in patients treated with anti-TNF α compared to other IBD treatment modalities.

The aim of this study was to evaluate the frequency of opportunistic infections in patients treated with anti-TNF α compared to those treated with thiopurine and to identify risk factors for opportunistic infection.

Methods: A total of 118 patients receiving anti-TNF α were identified at the Western General Hospital, Edinburgh. 38 patients were taking anti-TNF α plus another form of immunomodulator. 6 were taking concomitant steroids.

As a control 94 patients taking Azathioprine as a sole form of immunosupression were identified.

Demographic, clinical and treatment data were collected together with the frequency, type and severity of OI. Data were collected retrospectively using hospital electronic records.

Results: A total of 77 infectious events (39.8%) occurred in patients treated with anti-TNF α agents compared to 14 events (13.9%) in those receiving Azathioprine (p < 0.001). Infections experienced were also shown to be more severe in the group receiving anti-TNF α therapy as 13% required in-patient therapy compared to none receiving Azathioprine (p < 0.001).

Age, disease duration or treatment duration did not influence risk of OI.

39 patients were identified taking thiopurine in addition to anti-TNF α which yielded 13 infections (34.2%) which was not significantly significant. 6 patients were taking steroids in addition to anti-TNF α, 5 of whom had an infection (83.3%).

Conclusions: Opportunistic infections are more common in anti-TNF α treated patients than those on thiopurine alone.

The co-prescription of steroids is an additive risk factor.

The addition of thiopurine to anti-TNF α therapy did not increase the frequency of infection.