Vaccinations in immunosuppressed patients with IBD. The GP’s responsibility?
Crohn's disease
Opportunistic infection is always a risk in patients treated with immunosuppressant medication, such as those with inflammatory bowel disease (IBD). The risk can be reduced by vaccination, and shared care between the gastroenterologist and the GP can help ensure patients have the appropriate vaccinations.
Corticosteroids, 5-aminosalicylic acid (5-ASA) drugs and thiopurines (azathioprine and 6-mercaptopurine) have been the cornerstone of treatment of patients with inflammatory bowel disease (IBD) for decades. Methotrexate is also used occasionally. The introduction of the antitumour necrosis factor (anti-TNF) agents infliximab and adalimumab has been invaluable for people with severe Crohn’s disease and these biological agents also have a place in the treatment of people with moderate to severe ulcerative colitis who are not responding to usual therapy. However, these potent immunosuppressive drugs come with an increased risk of opportunistic infection. Appropriate vaccination is helpful in reducing this risk, but does not prevent it completely.1
Picture credit: © Gombert, Sigrid/SPL.