Serious infections in patients with inflammatory bowel disease and corticosteroids: A propensity score-matched study

Absolute risk estimates of serious infections in inflammatory bowel disease (IBD) across therapies and concomitant corticosteroid treatment are limited. We aimed to assess serious infection risk in IBD patients receiving different therapies, with or without corticosteroids.

Using nationwide Swedish registers (2007-2024), we compared rates of serious infections in patients with IBD treated with different therapies versus matched population comparators (≤10 per patient), stratified by corticosteroid use. We also performed 1:1 propensity score (PS)-matching for direct comparison of infection risk in IBD with or without concomitant corticosteroids exposure across advanced therapies. Incidence rates and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were calculated.

We identified 145,125 exposure periods in patients with IBD naïve to immunomodulators and advanced therapies, 82,675 to immunomodulators, and 90,181 to advanced therapies (TNF inhibitors with and without immunomodulator, anti-integrins, anti-interleukins, and JAK inhibitors). Across therapies, exposure periods with corticosteroids carried a higher risk of serious infections than periods without, both compared to the general population (incidence rate difference range=3.6-10.2/100 person-years; aHR range=4.52-15.86) and in PS-matched within therapy group comparisons (incidence rate difference range=3.9-8.5/100 person-years; aHR=1.82-3.60). Relative risk was highest in children and increased with cumulative corticosteroid dose.

Patients with IBD receiving corticosteroids had significantly higher rates of serious infections compared with those not receiving corticosteroids across therapies, with rate differences across age groups and combinations of treatments. These data will inform infection risk assessment and consideration of individualized infection-prevention strategies.