age is an important risk factor for infection in patients on anti-TNF therapy, 13,14 although the magnitude of this risk remains difficult to quantify.To assess this risk, we retrospectively reviewed the medical records of 349 patients with IBD (276 adults [215 patients aged <60 years, 61 patients aged ≥60 years] and 73 children) who were followed up at University Malaya Medical Center, Malaysia in the last 10 years. Among the patients, 186 (53%) were male and 163 (47%) were female. Approximately half of the patients had UC (n=187, 54%), 156 (45%) had CD, and 6 (2%) had IBD-unspecified. Seventy-four patients (21%) received anti-TNF therapy.In patients who were not exposed to anti-TNFs, the risk of non-IBD-related significant infectious complications was surprisingly very low, where 2 patients (0.7%) under the age of 60 years (1 adult and 1 child) developed pulmonary tuberculosis (TB). No patient in the older adult age group developed any significant infectious complications.In the group of patients who received anti-TNF, however,
INTRODUCTIONSince their first introduction in 1998, tumor necrosis factor inhibitor (anti-TNF) therapies have revolutionized the medical treatment of IBD. Anti-tumor necrosis factor (anti-TNF) is highly effective in inflammatory bowel disease (IBD); however, it is associated with an increased risk of infections, particularly in older adults. We reviewed 349 patients with IBD, who were observed over a 12-month period, 74 of whom had received anti-TNF therapy (71 patients were aged <60 years and 3 were aged ≥60 years). All the 3 older patients developed serious infectious complications after receiving anti-TNFs, although all of them were also on concomitant immunosuppressive therapy. One patient developed disseminated tuberculosis, another patient developed cholera diarrhea followed by nosocomial pneumonia, while the third patient developed multiple opportunistic infections (Pneumocystis pneumonia, cryptococcal septicemia and meningitis, Klebsiella septicemia). All 3 patients died within 1 year from the onset of the infection(s). We recommend that anti-TNF, especially when combined with other immunosuppressive therapy, should be used with extreme caution in older adult patients with IBD. (Intest Res 2017;15:524-528)