Inflammatory Bowel Disease Associated With Higher Bacterial, Viral Meningitis Risk

Study finds that patients with IBD and 1 or more comorbidities are at increased risk for viral or bacterial meningitis.

Patients with inflammatory bowel disease (IBD) have a higher risk for meningitis compared with people without IBD, and this risk increases in patients with comorbidities, according to a study published in the Journal of Clinical Gastroenterology.

Researchers conducted a retrospective cohort and nested case-control study to assess the incidence of and risk factors for meningitis among people with IBD. The cohort study analyzed insurance claims in the Quintiles IMS Legacy PharMetrics Adjudicated Claims Database from January 2001 to June 2016. The investigators also conducted a nested case-control study of patients with IBD to identify the predictors of meningitis, according to multivariable conditional logistic regression models. The primary exposure examined in this analysis was medication use. Patients with and without IBD were identified from this database, and both groups were compared in terms of the risk of meningitis. Patients in the non-IBD control group were matched to patients with IBD on age, sex, enrollment year, and region.

Among study patients with IBD, 50,029 had Crohn disease and 59,830 had ulcerative colitis. Patients were matched with 296,801 comparators without IBD. An incidence of meningitis was defined by one code for the disease that was associated with a hospitalization or a visit to the emergency department.

The median age of patients without IBD was 56 years, and the median ages of patients with Crohn disease and ulcerative colitis were 57 and 55 years, respectively. A total of 85 patients with Crohn disease, 77 patients with ulcerative colitis, and 235 patients without IBD had a claim for meningitis that was associated with hospitalization or an emergency department visit.

Patients with Crohn disease had a meningitis incidence rate ratio (IRR) of 2.17 (95% CI, 1.69-2.78), whereas patients with ulcerative colitis had an IRR of 1.63 (95% CI, 1.26-2.11). In the nested case-control study, treatment with mesalamine in patients with IBD was associated with lower odds of a meningitis claim (odds ratio [OR], 0.40; 95% CI, 0.26-0.62). Additionally, among patients with IBD, the presence of 1 or more comorbidity was associated with significantly higher odds of a meningitis claim (OR, 2.21; 95% CI, 1.76-2.77).

Limitations of this study were its retrospective nature as well as the reliance on insurance claims, which may have reduced the investigators’ ability to assess disease severity markers or other meningitis risk factors.

The investigators concluded that their findings reinforce the need for a pneumococcal vaccination in patients with IBD, recommendations that are “already a guideline for all [patients with Crohn disease] and ulcerative colitis on immunosuppressive regimens.”

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Kochar B, Jiang Y, Long MD. Patients with inflammatory bowel diseases are at higher risk for meningitis [published online May 29, 2020]. J Clin Gastroenterol. doi:10.1097/MCG.0000000000001365