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Medscape
7 days ago
- Health
- Medscape
Infections Common in IBD, Rates Vary by Treatment
TOPLINE: Patients with inflammatory bowel disease (IBD) experienced higher rates of mild and moderate infections. Women, smokers, those with multiple comorbidities, and those with exposure to certain IBD medications showed significantly higher rates of infections. METHODOLOGY: Researchers conducted a prospective observational study (June 2020 to July 2021) to evaluate the incidence of and risk factors for mild, moderate, and severe infections in 629 patients (mean age, 48.3 years; 58.2% women) with IBD who used an established remote monitoring platform for IBD management. They used the Patient-Reported Infections Questionnaire, a validated seven-item tool with a 3-month recall period, to collect data on 15 infection categories, including respiratory tract, urinary tract, and skin conditions and COVID-19. The presence or absence of disease activity was confirmed using a combination of monitoring questionnaire scores for patient-reported disease activity and faecal calprotectin levels. The severity of infection was categorised on the basis of the type and route of treatment as mild (self-limiting or requiring topical treatment), moderate (requiring oral treatment), or severe (requiring hospitalisation and/or intravenous treatment). Exposure to different medications, alone or in combination, was also assessed. TAKEAWAY: Overall, 991 infections were reported during 573.8 person-years of follow-up, with an overall incidence rate (IR) of 172.7 per 100 person-years, predominantly comprising mild (68%; IR, 117.5 per 100 person-years) and moderate (29.5%; IR, 50.9 per 100 person-years) infections. Women demonstrated significantly higher rates of infections than men (IR ratio [IRR], 1.70; P < .001), with increased rates of infections among current smokers vs non-smokers (IRR, 1.43; P = .004). Patients with a Charlson Comorbidity Index score > 2 had significantly higher rates of infections than those with lower scores (IRR for all infections, 1.69; P = .031). Glucocorticoid use more than doubled the rates of infections (IRR, 2.02; P = .033), and compared with no treatment, the use of JAK inhibitors, immunomodulator monotherapy, anti-TNF monotherapy, and combination therapy with anti-TNF and immunomodulators were associated with increased rates of infections. IN PRACTICE: "Clinicians should adopt a holistic approach that includes vigilant monitoring, preferably using validated tools, such as the PRIQ [Patient-Reported Infections Questionnaire], to identify patients with frequent mild or moderate infections. In addition, proactive application of preventive strategies, like vaccination, optimizing nutritional status, counselling for lifestyle modifications, and careful selection of therapies, should be used to reduce infection risk," the authors of the study wrote. SOURCE: This study was led by Ashkan Rezazadeh Ardabili, MD, Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, the Netherlands. It was published online on July 09, 2025, in the Journal of Crohn's and Colitis. LIMITATIONS: The study's 1‐year follow‐up coincided with COVID‐19 public health measures, likely underestimating overall rates of infections. This study was underpowered to precisely assess rare outcomes, and its real‐world design limited the control over the distribution of medication groups, especially when stratifying the analysis by IBD subtype. DISCLOSURES: This study was supported in part by an investigator-initiated research grant from Takeda. Some authors reported receiving grants, non-financial support, and research prizes and serving as speaker, advisor, and/or principal investigator for various institutions and pharmaceutical companies, including Takeda. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
14-05-2025
- Health
- Medscape
Brain Tissue Volume Predicts Late Stroke Treatment Success
A secondary analysis of the MR CLEAN-LATE trial found that penumbra volumes significantly modified the effectiveness of endovascular treatment (EVT) in patients with stroke in the late window, with greater benefits observed in those with larger penumbra volumes (≥ 120 mL). METHODOLOGY: This study was a post hoc secondary analysis of the MR CLEAN-LATE trial and included patients with anterior circulation large vessel occlusion and collateral flow observed on CT angiography in the late window after stroke (6-24 hours after stroke symptom onset or time last seen well). A total of 313 participants (median age, 73 years; 50% men) were randomly assigned to receive either EVT and best medical management (n = 145) or best medical management alone (n = 168). The functional outcome was measured at 90 days using the modified Rankin Scale (mRS) score. Researchers examined treatment effectiveness in subgroups on the basis of core volumes, penumbra volumes, and mismatch ratios, with adjustments for prognostic factors including age, prestroke mRS score, and baseline National Institutes of Health Stroke Scale score. TAKEAWAY: The treatment effect varied significantly by penumbra volume ( P < .001 for interaction), showing the greatest benefit in patients with penumbra volumes ≥ 120 mL (adjusted common odds ratio [ACOR], 6.89; 95% CI, 2.96-16.04) and the least benefit in those with penumbra volumes ≤ 72 mL (ACOR, 0.49; 95% CI, 0.22-1.08). < .001 for interaction), showing the greatest benefit in patients with penumbra volumes ≥ 120 mL (adjusted common odds ratio [ACOR], 6.89; 95% CI, 2.96-16.04) and the least benefit in those with penumbra volumes ≤ 72 mL (ACOR, 0.49; 95% CI, 0.22-1.08). Core volumes and mismatch ratios did not alter the effect of EVT on functional outcomes at 90 days. Larger core volumes were associated with an increased risk for clinical stroke progression (adjusted OR per 10 mL, 1.16; 95% CI, 1.01-1.33) and an increase in infarct volume. Mismatch ratios were inversely associated with infarct volume. IN PRACTICE: "This study suggests that after selection based on collateral flow, core volume and mismatch ratio did not seem to have additional value in patient selection; penumbra size, however, modified the association of endovascular treatment with outcomes, with a trend toward potential harm in patients with the smallest penumbras," the authors wrote. SOURCE: This study was led by Susanne G.H. Olthuis, MD, Maastricht University Medical Centre+, Maastricht, the Netherlands. It was published online on May 5 in JAMA Neurology . LIMITATIONS: This analysis was exploratory and not powered for CT perfusion (CTP)–specific outcomes. CTP data were available for only 62% of patients, potentially introducing bias due to missing data. Additionally, the findings were not generalisable to rural or unselected patient populations. DISCLOSURES: The MR CLEAN-LATE trial was funded by the Collaboration for New Treatments of Acute Stroke Consortium, supported by the Netherlands Cardiovascular Research Initiative and the Netherlands Brain Foundation. The collaboration project received additional financing from the Ministry of Economic Affairs. Unrestricted funding was provided by Stryker, Medtronic, and Cerenovus. Several authors reported receiving institutional grants or personal fees from industry and non-profit funders, with one disclosing a minority stake in Nicolab. Details are provided in the original article.
