The Risk of Serious Infections Before and After Anti-TNF Therapy in Inflammatory Bowel Disease: A Retrospective Cohort Study

Johanna Holmgren; Anna Fröborg; Isabella Visuri; Jonas Halfvarson; Henrik Hjortswang; Pontus Karling; Pär Myrelid; Ola Olén; Jonas F Ludvigsson; Olof Grip; SWIBREG Study Group

doi:10.1093/ibd/izac097

The Risk of Serious Infections Before and After Anti-TNF Therapy in Inflammatory Bowel Disease: A Retrospective Cohort Study

Johanna Holmgren, Anna Fröborg, Isabella Visuri, Jonas Halfvarson, Henrik Hjortswang, Pontus Karling, Pär Myrelid, Ola Olén, Jonas F Ludvigsson, Olof Grip, SWIBREG Study Group

Internal Medicine - Epidemiology

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Serious infections have been observed in patients with inflammatory bowel disease (IBD) on anti-TNF use-but to what extent these infections are due to anti-TNF or the disease activity per se is hard to disentangle. We aimed to describe how the rates of serious infections change over time both before and after starting anti-TNF in IBD.

METHODS: Inflammatory bowel disease patients naïve to anti-TNF treatment were identified at 5 centers participating in the Swedish IBD Quality Register, and their medical records examined in detail. Serious infections, defined as infections requiring in-patient care, the year before and after the start of anti-TNF treatment were evaluated.

RESULTS: Among 980 patients who started their first anti-TNF therapy between 1999 and 2016, the incidence rate of serious infections was 2.19 (95% CI,1.43-3.36) per 100 person years the year before and 2.11 (95% CI, 1.33-3.34) per 100 person years 1 year after treatment start. This corresponded to an incidence rate ratio 1 year after anti-TNF treatment of 0.97 (95% CI, 0.51-1.84). Compared with before anti-TNF therapy, the incidence of serious infection was significantly decreased more than 1 year after treatment (incidence rate ratio 0.56; 95% CI, 0.33-0.95; P = .03).

CONCLUSIONS: In routine clinical practice in Sweden, the incidence rate of serious infection among IBD patients did not increase with anti-TNF therapy. Instead, serious infections seemed to decrease more than 1 year after initiation of anti-TNF treatment.

Original language	English
Pages (from-to)	339-348
Journal	Inflammatory Bowel Diseases
Volume	29
Issue number	3
Early online date	2022 Jul 1
DOIs	https://doi.org/10.1093/ibd/izac097
Publication status	Published - 2023

Bibliographical note

Subject classification (UKÄ)

Infectious Medicine
Gastroenterology and Hepatology
Public Health, Global Health, Social Medicine and Epidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/ibd/izac097Licence: CC BY-NC

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Holmgren, J., Fröborg, A., Visuri, I., Halfvarson, J., Hjortswang, H., Karling, P., Myrelid, P., Olén, O., Ludvigsson, J. F., Grip, O., & SWIBREG Study Group (2023). The Risk of Serious Infections Before and After Anti-TNF Therapy in Inflammatory Bowel Disease: A Retrospective Cohort Study. Inflammatory Bowel Diseases, 29(3), 339-348. https://doi.org/10.1093/ibd/izac097

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title = "The Risk of Serious Infections Before and After Anti-TNF Therapy in Inflammatory Bowel Disease: A Retrospective Cohort Study",

abstract = "BACKGROUND: Serious infections have been observed in patients with inflammatory bowel disease (IBD) on anti-TNF use-but to what extent these infections are due to anti-TNF or the disease activity per se is hard to disentangle. We aimed to describe how the rates of serious infections change over time both before and after starting anti-TNF in IBD.METHODS: Inflammatory bowel disease patients na{\"i}ve to anti-TNF treatment were identified at 5 centers participating in the Swedish IBD Quality Register, and their medical records examined in detail. Serious infections, defined as infections requiring in-patient care, the year before and after the start of anti-TNF treatment were evaluated.RESULTS: Among 980 patients who started their first anti-TNF therapy between 1999 and 2016, the incidence rate of serious infections was 2.19 (95% CI,1.43-3.36) per 100 person years the year before and 2.11 (95% CI, 1.33-3.34) per 100 person years 1 year after treatment start. This corresponded to an incidence rate ratio 1 year after anti-TNF treatment of 0.97 (95% CI, 0.51-1.84). Compared with before anti-TNF therapy, the incidence of serious infection was significantly decreased more than 1 year after treatment (incidence rate ratio 0.56; 95% CI, 0.33-0.95; P = .03).CONCLUSIONS: In routine clinical practice in Sweden, the incidence rate of serious infection among IBD patients did not increase with anti-TNF therapy. Instead, serious infections seemed to decrease more than 1 year after initiation of anti-TNF treatment.",

author = "Johanna Holmgren and Anna Fr{\"o}borg and Isabella Visuri and Jonas Halfvarson and Henrik Hjortswang and Pontus Karling and P{\"a}r Myrelid and Ola Ol{\'e}n and Ludvigsson, {Jonas F} and Olof Grip and {SWIBREG Study Group}",

note = "{\textcopyright} 2022 Crohn{\textquoteright}s & Colitis Foundation. Published by Oxford University Press on behalf of Crohn{\textquoteright}s & Colitis Foundation.",

year = "2023",

doi = "10.1093/ibd/izac097",

language = "English",

volume = "29",

pages = "339--348",

journal = "Inflammatory Bowel Diseases",

issn = "1536-4844",

publisher = "Oxford University Press",

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Holmgren, J, Fröborg, A, Visuri, I, Halfvarson, J, Hjortswang, H, Karling, P, Myrelid, P, Olén, O, Ludvigsson, JF, Grip, O & SWIBREG Study Group 2023, 'The Risk of Serious Infections Before and After Anti-TNF Therapy in Inflammatory Bowel Disease: A Retrospective Cohort Study', Inflammatory Bowel Diseases, vol. 29, no. 3, pp. 339-348. https://doi.org/10.1093/ibd/izac097

TY - JOUR

T1 - The Risk of Serious Infections Before and After Anti-TNF Therapy in Inflammatory Bowel Disease

T2 - A Retrospective Cohort Study

AU - Holmgren, Johanna

AU - Fröborg, Anna

AU - Visuri, Isabella

AU - Halfvarson, Jonas

AU - Hjortswang, Henrik

AU - Karling, Pontus

AU - Myrelid, Pär

AU - Olén, Ola

AU - Ludvigsson, Jonas F

AU - Grip, Olof

AU - SWIBREG Study Group

PY - 2023

Y1 - 2023

N2 - BACKGROUND: Serious infections have been observed in patients with inflammatory bowel disease (IBD) on anti-TNF use-but to what extent these infections are due to anti-TNF or the disease activity per se is hard to disentangle. We aimed to describe how the rates of serious infections change over time both before and after starting anti-TNF in IBD.METHODS: Inflammatory bowel disease patients naïve to anti-TNF treatment were identified at 5 centers participating in the Swedish IBD Quality Register, and their medical records examined in detail. Serious infections, defined as infections requiring in-patient care, the year before and after the start of anti-TNF treatment were evaluated.RESULTS: Among 980 patients who started their first anti-TNF therapy between 1999 and 2016, the incidence rate of serious infections was 2.19 (95% CI,1.43-3.36) per 100 person years the year before and 2.11 (95% CI, 1.33-3.34) per 100 person years 1 year after treatment start. This corresponded to an incidence rate ratio 1 year after anti-TNF treatment of 0.97 (95% CI, 0.51-1.84). Compared with before anti-TNF therapy, the incidence of serious infection was significantly decreased more than 1 year after treatment (incidence rate ratio 0.56; 95% CI, 0.33-0.95; P = .03).CONCLUSIONS: In routine clinical practice in Sweden, the incidence rate of serious infection among IBD patients did not increase with anti-TNF therapy. Instead, serious infections seemed to decrease more than 1 year after initiation of anti-TNF treatment.

AB - BACKGROUND: Serious infections have been observed in patients with inflammatory bowel disease (IBD) on anti-TNF use-but to what extent these infections are due to anti-TNF or the disease activity per se is hard to disentangle. We aimed to describe how the rates of serious infections change over time both before and after starting anti-TNF in IBD.METHODS: Inflammatory bowel disease patients naïve to anti-TNF treatment were identified at 5 centers participating in the Swedish IBD Quality Register, and their medical records examined in detail. Serious infections, defined as infections requiring in-patient care, the year before and after the start of anti-TNF treatment were evaluated.RESULTS: Among 980 patients who started their first anti-TNF therapy between 1999 and 2016, the incidence rate of serious infections was 2.19 (95% CI,1.43-3.36) per 100 person years the year before and 2.11 (95% CI, 1.33-3.34) per 100 person years 1 year after treatment start. This corresponded to an incidence rate ratio 1 year after anti-TNF treatment of 0.97 (95% CI, 0.51-1.84). Compared with before anti-TNF therapy, the incidence of serious infection was significantly decreased more than 1 year after treatment (incidence rate ratio 0.56; 95% CI, 0.33-0.95; P = .03).CONCLUSIONS: In routine clinical practice in Sweden, the incidence rate of serious infection among IBD patients did not increase with anti-TNF therapy. Instead, serious infections seemed to decrease more than 1 year after initiation of anti-TNF treatment.

U2 - 10.1093/ibd/izac097

DO - 10.1093/ibd/izac097

M3 - Article

C2 - 35776552

SN - 1536-4844

VL - 29

SP - 339

EP - 348

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

IS - 3

ER -

The Risk of Serious Infections Before and After Anti-TNF Therapy in Inflammatory Bowel Disease: A Retrospective Cohort Study

Abstract

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UN SDGs

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