Increased Risk of Respiratory Syncytial Virus Among Patients With Inflammatory Bowel Disease

Introduction: Subsets of patients with inflammatory bowel disease (IBD) can be immunosuppressed due to their underlying disease or as a consequence of medical therapy and are at increased risk of developing infections with respiratory pathogens including influenza, pneumococcus, and SARS-CoV-2. Respiratory syncytial virus (RSV) is a common respiratory virus that has known adverse outcomes in elderly and immunosuppressed populations, although research is limited. With the development of multiple RSV vaccines, determining whether patients with IBD are at increased risk for RSV infection can assist in informing appropriate vaccination strategies. Methods: We conducted a retrospective study using the multi-institutional research network TriNetX to assess the risk of RSV infection in a cohort of patients with IBD compared to a non-IBD control cohort. One-to-one (1:1) propensity score matching (PSM) was performed for demographic variables, RSV risk factors and IBD medications between the 2 cohorts. Risk was expressed as adjusted odds ratio (aOR) with 95% confidence interval (CI). Results: A total of 206,475 patients with IBD and 4,166,977 in the non-IBD cohort were identified that had an RSV infection. The IBD cohort was at an increased risk for RSV infection (aOR 2.24, 95% CI 1.96-2.55) (Figure 1). When evaluating risk factors for RSV infections among patients with IBD, those with diabetes mellitus (aOR 1.20, 95% CI 1.007-1.44) chronic lung disease (aOR 1.21, 95% CI 1.06-1.39), cardiovascular disease (aOR 1.18, 95% CI 1.01-1.37), and CKD (aOR 1.52, 95% CI 1.21-1.92), were at increased risk for RSV infection (Figure 1). Patients in the IBD cohort on 5-ASA (aOR 1.77, 95% CI 1.39-2.25), thiopurines or methotrexate (aOR 3.06, 95% CI 2.09-4.49) and anti-Tumor Necrosis Factor therapy (aOR 1.66, 95% CI 1.10-2.52) were at an increased risk of RSV infection (Figure 1). Patients with IBD were also at increased risk for hospitalization due to RSV infections compared to non-IBD controls (aOR 1.36, 95% CI 1.09-1.69). When analyzed by age, risk for hospitalization was increased in specific patients with IBD aged 18-49 (aOR 1.73, 95% CI 1.15-2.60) and > 65 years old (aOR1.43, 95% CI 1.03-1.99), but no difference was found between cohorts for patients >50 years old. Conclusion: We found that adult patients with IBD are at an increased risk of RSV infection and hospitalizations from the infection. This would suggest all adult patients with IBD may benefit from the new RSV vaccine recommended for adults 60 years and older.Figure 1.: Risk of RSV in the IBD cohort and non-IBD control cohort expressed as adjusted odds ratio (aOR) with 95% confidence intervals (CI).