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Background <p>Patients with active inflammatory bowel disease (IBD) often require immunosuppressive therapy to achieve and maintain remission; however, the impact of these medications on influenza risk and the severity of influenza-related complications remains inadequately characterized.</p> Methods <p>Using the TriNetX U.S. Analytics Network, adults (≥ 18&#xa0;years) with Crohn’s disease or ulcerative colitis during the 2022–2023 influenza season were identified. Patients were stratified by disease activity into two cohorts: (1) active IBD, defined by elevated inflammatory markers, initiation of corticosteroids or a new biologic or small-molecule agent, or documented IBD-related symptoms or complications within the prior six months; and (2) inactive IBD, defined by the absence of these features and no recent immunosuppressive therapy. Propensity score matching (1:1) was used to balance baseline characteristics, and Cox proportional hazards models were applied to estimate hazard ratios for influenza-related outcomes.</p> Results <p>After propensity score matching, each group had 22,784 patients. The incidence of influenza diagnosis was significantly higher in the active IBD group (HR 1.41; 95% CI 1.30–1.52). Hospitalization rates were also increased (HR 2.05; 95% CI 1.89–2.23), as were influenza-related complications (HR 1.36; 95% CI 1.23–1.51). ICU admissions (HR 1.51; 95% CI 1.33–1.72) and mechanical ventilation (HR 1.68; 95% CI 1.32–2.13) were both more frequent in the active IBD group. Use of antiviral medications was higher among patients with active IBD (HR 1.60; 95% CI 1.22–2.10), and overall mortality was modestly increased (HR 1.17; 95% CI 1.02–1.35). Subgroup analysis revealed the highest risk among patients on corticosteroids, followed by JAK inhibitors and anti–IL-23 agents.</p> Conclusion <p>Patients with active IBD had more severe influenza-related outcomes compared with those with&#xa0;inactive IBD. Improving vaccine uptake and prompt evaluation of upper respiratory symptoms during influenza seasons are key to reducing influenza-related risks in immunosuppressed patients with IBD.</p>

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Severe Influenza-Related Outcomes in Patients with Inflammatory Bowel Disease on Immunosuppressive Therapy: A Propensity-Matched Cohort Analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月6日

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  • Mohamed H. Eldesouki,
  • Ahmed Ibrahim,
  • Omar Alkasabrah,
  • Mohammed Y. Youssef,
  • Eslam Mohamed,
  • Saqr Alsakarneh,
  • Francis A. Farraye,
  • Jana G. Hashash

摘要

Background

Patients with active inflammatory bowel disease (IBD) often require immunosuppressive therapy to achieve and maintain remission; however, the impact of these medications on influenza risk and the severity of influenza-related complications remains inadequately characterized.

Methods

Using the TriNetX U.S. Analytics Network, adults (≥ 18 years) with Crohn’s disease or ulcerative colitis during the 2022–2023 influenza season were identified. Patients were stratified by disease activity into two cohorts: (1) active IBD, defined by elevated inflammatory markers, initiation of corticosteroids or a new biologic or small-molecule agent, or documented IBD-related symptoms or complications within the prior six months; and (2) inactive IBD, defined by the absence of these features and no recent immunosuppressive therapy. Propensity score matching (1:1) was used to balance baseline characteristics, and Cox proportional hazards models were applied to estimate hazard ratios for influenza-related outcomes.

Results

After propensity score matching, each group had 22,784 patients. The incidence of influenza diagnosis was significantly higher in the active IBD group (HR 1.41; 95% CI 1.30–1.52). Hospitalization rates were also increased (HR 2.05; 95% CI 1.89–2.23), as were influenza-related complications (HR 1.36; 95% CI 1.23–1.51). ICU admissions (HR 1.51; 95% CI 1.33–1.72) and mechanical ventilation (HR 1.68; 95% CI 1.32–2.13) were both more frequent in the active IBD group. Use of antiviral medications was higher among patients with active IBD (HR 1.60; 95% CI 1.22–2.10), and overall mortality was modestly increased (HR 1.17; 95% CI 1.02–1.35). Subgroup analysis revealed the highest risk among patients on corticosteroids, followed by JAK inhibitors and anti–IL-23 agents.

Conclusion

Patients with active IBD had more severe influenza-related outcomes compared with those with inactive IBD. Improving vaccine uptake and prompt evaluation of upper respiratory symptoms during influenza seasons are key to reducing influenza-related risks in immunosuppressed patients with IBD.