Frailty Increased in Patients With IBD After Immunosuppression

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As frailty has been linked to outcomes in patients with other inflammatory diseases, the researchers examined the relationship between frailty and the risk for infections after immunosuppression for inflammatory bowel disease.

The treatment of patients with inflammatory bowel disease (IBD) with immunosuppression therapy resulted in higher frailty, after correcting for age and comorbidities, according to cohort study results published in Gastroenterology.

Investigators assessed patients with IBD (N=3975) using the validated frailty definition from the International Classification of Disease codes. They compared patient status between the 2 years before receiving anti-tumor necrosis factor (TNF) (n=1299; age 25-50 years) or immunomodulator therapy (n=2676; age 27-54 years) and the first year after receiving treatment. All patients were treated between 1996 and 2010 at 2 hospitals in the New England region of the United States.

Few patients were frail in the 2 years before IBD treatment (5% anti-TNF and 7% immunomodulator). A significantly higher percentage (P <.01) of the frail patients at the onset of therapy developed infections (19% anti-TNF and 17% immunomodulator) compared with fit patients (9% anti-TNF and 7% immunomodulator). After correcting for age, comorbidities, and concomitant medications, frailty remained higher in the patients who were not fit at the beginning of treatment with adjusted odds ratios (aORs) of 2.05 (95% CI, 1.07-3.93) for the anti-TNF group and 1.81 (95% CI, 1.22-2.7) for the immunomodulator cohort.

Patients who had a previous IBD-related hospitalization and surgery, patients with additional comorbidities, and patients who had concomitant immunomodulators all had higher rates of frailty (aOR 3.49; P =.04; aOR 3.21; 95% CI, 1.79-5.76; and aOR 1.76; 95% CI, 1.21-2.57, respectively).

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No significant difference in frailty was observed between type of IBD (Crohn disease [aOR 1.87; 95% CI, 0.91-3.84] or ulcerative colitis [aOR 2.77; 95% CI, 0.52-14.08]).

A study limitation is the reliance on the International Classification of Diseases codes for diagnosing patients as frail or fit. It is unclear whether the frailty of patients is accurate or if underreporting and/or misclassification has affected patient classification.

The investigators concluded that frailty is associated with an increase in infections after receiving immunosuppression therapy for treatment of IBD. Clinicians need to incorporate systematic frailty assessment for patients with IBD and implement additional strategies that may improve patient well-being.

Disclosures: Some declared author affiliations are with the pharmaceutical industry. A complete list of disclosures can be found in the original study.

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Kochar B, Cai W, Cagan A, et al. Pre-treatment frailty is independently associated with increased risk of infections after immunosuppression in patients with inflammatory bowel diseases [published online February 24, 2020] Gastroenterology. doi:10.1053.j.gastro.2020.02.032