SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Philippe SEKSIK
Coup de coeur :
 
 
Gastroenterology
  2018/08  
 
  2018 Aug;155(2):337-346.e10.  
  doi: 10.1053/j.gastro.2018.04.012.  
 
  Risk of Serious and Opportunistic Infections Associated With Treatment of Inflammatory Bowel Diseases  
 
  Kirchgesner J, Lemaitre M, Carrat F, Zureik M, Carbonnel F, Dray-Spira R  
  https://www.ncbi.nlm.nih.gov/pubmed/29655835  
 
 

Abstract
 

BACKGROUND & AIMS:

The risk of infection associated with tumor necrosis factor antagonists (anti-TNF) and thiopurines (combination therapy) is uncertain. We assessed the risk of serious and opportunistic infections in patients with inflammatory bowel disease (IBD) treated with thiopurine monotherapy, anti-TNF monotherapy, or combination therapy in a large cohort of patients in France.

METHODS:

We performed a nationwide population-based study of patients (18 years or older) with a diagnosis of IBD in the French national health insurance database; we collected data from January 1, 2009 until December 31, 2014. The risks of serious and opportunistic infections associated with exposure to combination therapy, anti-TNF, and thiopurine monotherapies were compared using marginal structural Cox proportional hazard models adjusted for baseline and time-varying sociodemographic characteristics, medications, and comorbidities.

RESULTS:

Among the 190,694 patients with IBD included in our analysis, 8561 serious infections and 674 opportunistic infections occurred. Compared with anti-TNF monotherapy, combination therapy was associated with increased risks of serious infection (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.05-1.45) and opportunistic infection (HR, 1.96; 95% CI, 1.32-2.91). Compared with thiopurine monotherapy, anti-TNF monotherapy was associated with increased risks of serious infection (HR, 1.71; 95% CI, 1.56-1.88), mycobacterial infection (HR, 1.98; 95% CI, 1.15-3.40), and bacterial infection (HR, 2.38; 95% CI, 1.23-4.58, respectively). Conversely, anti-TNF monotherapy was associated with decreased risk of opportunistic viral infection compared with thiopurine monotherapy (HR, 0.57; 95% CI, 0.38-0.87).

CONCLUSIONS:

In a nationwide cohort study of patients with IBD in France, we found heterogeneity in risks of serious and opportunistic infections in patients treated with immune-suppressive regimens. These should be carefully considered and weighed against potential benefits for IBD treatment in patient management.

 
Question posée
 
Quel est le risque d’infection sévère ou opportuniste chez les patients sous immunosuppresseurs (mono-combothérapie) au cours des MICI ?
 
Question posée
 
Cette étude de cohorte à l’échelle nationale montre un risque accru d’infection sévère sous anti-TNF monothérapie par rapport à une monothérapie par thiopurine et un risque accru d’infection sévère et opportuniste sous combothérapie par rapport à une monothérapie anti-TNF.
 
Commentaires

Très belle étude française en population à partir des données médico-administratives regroupant plus de 190000 MICI. La limite principale est le diagnostic d’infection sévère ou opportuniste qui ne repose que sur le codage.

 
www.snfge.org