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Journal of Crohn's and Colitis: 10 (11)


Laurence J. Egan, Ireland

Associate Editors

Shomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKJesús Rivera-Nieves, USABritta Siegmund, GermanyGijs van den Brink, NLSéverine Vermeire, Belgium


Published on behalf of

Increased risk of pneumonia among patients with inflammatory bowel disease: A comparison between patients treated with biologic therapies and with conventional drugs

Claudia Romano, Emanuele Sinagra, Valeria Criscuoli, Ambrogio Orlando, Simonetta Maisano, Mario Cottone
DOI: http://dx.doi.org/10.1016/j.crohns.2013.04.015 e405-e406 First published online: 1 October 2013

Dear Sir,

Recent evidences show that the patients with inflammatory bowel diseases (IBDs) are at increased risk for pneumonia (1); furthermore, medications such as corticosteroids, thiopurines, biologic drugs, proton-pump inhibitors, and narcotics seem to be associated with such risk of pneumonia.1

We report our series of the risk of pneumonia in two cohorts of patients with IBD, the first one under biological treatment, and the other one under other conventional therapies, through a retrospective analysis.

The occurrence of pneumonia was investigated, from diagnosis of IBD to the end of follow up, in a first cohort of 283 consecutive IBD patients treated with biological treatment (105 patients treated with adalimumab and affected by Crohn's disease (CD), and 178 patients treated with infliximab, of which 123 affected by CD and 55 affected by ulcerative colitis (UC)) followed from January 2006 to December 2012 in our tertiary referral center. Patients were followed prospectively and all complications during treatment were recorded. All patients underwent clinical screening, chest X-ray and TBC testing. Pieces of information were collected in all patients on the presence or appearance of pulmonary manifestations and in particular of episodes of pneumonia after diagnosis and during the course of the disease.

Furthermore, a second cohort of 235 consecutive IBD patients treated with conventional therapies, and followed from April 2011 to December 2012 in our tertiary referral center, was retrospectively evaluated (113 affected by CD and 122 affected by UC) on the occurrence of pneumonia since diagnosis of IBD. Every patient was examined, through a questionnaire, about the presence of pulmonary manifestations from the onset of the IBD to the end of the outpatient follow up, focusing on the pneumonia requiring hospitalizations (data from ICD code-9).

The risk of pneumonia was evaluated through the person–years method, thus the incidence of pneumonia was compared in both the populations using the chi-square test.

In the cohort of patients under biological treatment 4 cases of pneumonia (2 interstitial, 2 infectious) over 3405 year–person (incidence 0,11%) were reported. The median age was 39.2 years (range 14–75).

In the cohort of patients under conventional therapies 3 cases of infectious pneumonia requiring hospitalization, over 2764 year–persons (incidence 0.10%) were reported. The difference in the incidence rate of pneumonia, between the two cohorts, was not significant (p = 0.8). The median age was 42.6 years (range 17–83).

Our study shows that the incidence of pneumonia, in a cohort of IBD patients under conventional therapies is comparable to that one cohort of IBD patients under biological treatment. Since we have no control population of non-IBD patients it is impossible to state that pneumonia was more frequent in IBD patients. However, our data are comparable to the results arising from the registrative trials of the biological drugs.24 Nevertheless, to obtain reliable data about the real incidence of pneumonia, in the different subsets of IBD patients, a prospective analysis on incident cases is needed.

Conflict of interests

None declared for all the authors.


  • 1 Emanuele Sinagra and Claudia Romano share the 1st authorship and contributed equally to the work.


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