Infecções graves ou oportunistas em pacientes com doença inflamatória intestinal: incidência e fatores de risco

Abstract

The introduction of immunosuppressive agents, including biologics and Janus kinase (JAK) inhibitors, has revolutionized the treatment of inflammatory bowel disease (IBD), but raised concerns about the risk of severe and opportunistic infections (OIs). This study aimed to evaluate the incidence and risk factors for severe infections and OIs in patients with IBD undergoing immunosuppressive therapy, compared to non-immunosuppressed patients. We conducted an ambispective cohort study involving 498 adult patients with IBD followed at the IBD Center of the University Hospital of the Federal University of Juiz de Fora, Brazil, between March 2014 and April 2024. Retrospective data were collected from 2014 to 2021, and prospective data collection was carried out from 2021 onward. The incidence rate (IR) was calculated as the number of events per 1,000 patient-years (PY), and risks were assessed using Cox proportional hazard models adjusted for age and sex. Over a total of 3,279.6 PY of follow-up, severe infections were identified in 7% of patients (IR: 10.7/1,000 PY) and OIs in 12% (IR: 18.3/1,000 PY). The most frequent OIs were herpes zoster (5.6%; IR: 8.5/1,000 PY) and tuberculosis (3.4%; IR: 5.18/1,000 PY). The risk of OIs was significantly higher among patients receiving combination therapy with anti-TNF and azathioprine (adjusted hazard ratio [aHR]: 6.86; 95% confidence interval [CI]: 1.97–23.92), followed by thiopurine monotherapy (aHR: 5.02; 95% CI: 1.45–17.33) and anti-TNF monotherapy (aHR: 4.70; 95% CI: 1.39–15.96), compared to non-immunosuppressed patients. These findings reinforce that anti-TNF and/or thiopurine therapy is associated with a higher risk of OIs, particularly herpes zoster and tuberculosis. Therefore, therapeutic decisions in IBD should carefully balance efficacy and long-term safety.