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P453. Incidence of side effects and unspecific infections in the therapy with immunosuppressive therapeutics: a prospective observational study in 158 IBD patients

S. Mair, Y. Atabay, K. Mayer, A. Petersen, R.M. Schmid, W. Huber, Technical University Munich, II. Medical Department, Munich, Germany

Background

Glucocorticoids, aminosalicylates, immunosuppressants and-modulators are standard therapeutics in the treatment of inflammatory bowel disease-patients. Glucocorticoids are mainly used for the induction of remission, whereas aminosalicylates, azathioprine and TNF-alpha-antibodies are also used for the maintenance-therapy. In the therapy with these therapeutics severe and non-severe side effects as well as a increased incidence of unspecific infections have been described and patients are regularly screened for severe side effects. However, mild side effects, i.e. itching and rash, and mild infections with flew-like symptoms are likely to be missed. Yet patients might experience a substantial decrease in their well being due to rather mild and unspecific symptoms. As a consequence adherence to therapy might be decreased. Therefore, this study prospectively investigates the attribution of side effects and unspecific infections to single therapeutics by 158 IBD-outpatients of a university hospital.

Methods

Over 6 months 158 consecutive IBD patients were asked if they experienced side effects and a higher incidence of infections during the therapy with a therapeutic and whether they attribute this incidence to the therapeutic. The attributed incidence was assessed in a questionnaire.

Results

Mean age 42.0±14.2 years, 90 female, 68 male. Underlying diseases: 90/158 (57.0%) Morbus Crohn, 63/158 (39.9%) Colitis ulcerosa, 57158 (3.2%) colitis indeterminata. 32/158 (20.3%) patients were treated with systemic steroids, 44/158 (27.8%) topical steroids, 59/158 (37.3%) aminosalicylates, 42/158 (26.6%) azathioprine, 19/158 (12.0%) infliximab and 12/158 (7.6%) with adalimumab. The incidence of unspecific infections and side effects in the treatment with systemic steroids was 6/32 (18.8%) and 25/32 (78.1%), with topic steroids 2/44 (4.5%) and 7/44 (15.9%), with aminosalycilates 3/59 (5.1%) and 7/59 (11.9%), with azathioprine 6/42 (14.3%) and 14/42 (33.3%), with infliximab 0/19 (0%) and 4/19 (21.1%), with adalimumab 5/12 (41.7%) and 6/12 (50%).

Conclusion

According to the questionnaire IBD patients frequently experience side effects and have a substantial incidence of infections. Patients often attribute the incidence of side effects and infections to a specific therapeutic. This perception might lead to a decreased adherence of therapy. Generally IBD patients should frequently be screened for the manifestation of side effects and for a higher incidence of infections.