Abstract

Frailty and Risk of Serious Infections in Biologic-treated Patients With Inflammatory Bowel Diseases

Inflamm Bowel Dis. 2021 Oct 18;27(10):1626-1633. doi: 10.1093/ibd/izaa327.

Siddharth Singh 1 2, Herbert C Heien 3, Lindsey Sangaralingham 3, Nilay D Shah 3 4, Jennifer C Lai 5, William J Sandborn 1, Alison A Moore 6

 
     

Author information

  • 1Division of Gastroenterology and Department of Medicine, University of California San Diego, La Jolla, California, USA.
  • 2Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California, USA.
  • 3Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
  • 4Division of Health Care Policy and Research, Department of Health Services Research, Mayo Clinic, Rochester, Minnesota, USA.
  • 5Division of Gastroenterology and Hepatology Department of Medicine University of California San Francisco, San Francisco, California, USA.
  • 6Division of Geriatrics and Gerontology, Department of Medicine, University of California San Diego, La Jolla, California, USA.

Abstract

Background: Identifying biologic-treated patients with inflammatory bowel diseases (IBDs) at higher risk of serious infections is a priority. We conducted a retrospective cohort study evaluating frailty and risk of serious infections in biologic-treated patients with IBD.

Methods: Using an administrative claims database, we identified biologic-treated patients with IBD between 2014 and 2018 with follow-up 1 year before and after treatment initiation. Using a validated claims-based hospital frailty risk scoring system, patients were classified as frail and nonfrail. We compared the risk of serious infections (infections requiring hospitalization) between frail and nonfrail patients using Cox proportional hazard analysis adjusting for age, comorbidities, disease characteristics, health care utilization, use of corticosteroids, immunomodulators, and opiates.

Results: We included 5987 biologic-treated patients with IBD (4881 on TNFα antagonists, 1106 on vedolizumab), of whom 2350 (39.3%) were classified as frail; over 7115 person-years of follow-up was included, and 520 patients developed serious infection. Frailty was not associated with increased risk of serious infection (adjusted hazard ratio [aHR], 1.12; 95% CI, 0.93-1.36), whereas advanced age (older than 60 years), high comorbidity burden, corticosteroid use, opiate use, and prior serious infection were associated with increased risk of serious infection. On stratified analysis, frailty was associated with increased risk of serious infections in vedolizumab-treated patients (aHR, 1.69; 95% CI, 1.03-2.79) but not in TNFα antagonist-treated patients (aHR, 1.03; 95% CI, 0.83-1.27).

Conclusions: In biologic-treated patients with IBD, frailty assessed using a claims-based frailty index was not independently associated with increased risk of serious infections. Future studies evaluating objective and biological measures of frailty are warranted to risk-stratify older patients with IBD.

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