Active IBD and Steroid Use Linked to Higher RSV Risk
Patients with active inflammatory bowel disease (IBD) face a higher risk of respiratory syncytial virus (RSV) infection and related complications, particularly when treated with systemic corticosteroids, according to a large real-world analysis using the TriNetX network. The findings highlight the role of disease activity and medication choice in respiratory infection risk.
Investigators analyzed 160,224 adults with IBD between October 2024 and March 2025, stratifying patients into active and non-active disease cohorts based on recent immunosuppressive use or complications. After propensity matching, each cohort included 66,446 patients. Outcomes were assessed over 180 days.
RSV infection occurred more frequently in patients with active IBD compared with non-active disease (0.32% vs 0.11%; OR 2.36; p<0.01). Active disease was also associated with increased rates of bacterial pneumonia, ICU admission, and mechanical ventilation. The authors noted that “patients with active IBD experienced a significantly higher risk of RSV infection and related complications.”
Systemic corticosteroid use was the strongest driver of risk. Patients receiving steroids had markedly higher RSV infection rates (HR 2.70), while no increased risk was observed with biologic or small molecule therapies, including TNF inhibitors, IL-23/IL-12/23 agents, integrin inhibitors, or JAK inhibitors.
Vaccination appeared to mitigate risk. Among vaccinated patients with active IBD, RSV infection rates were no longer significantly different compared with those with non-active disease, and complication rates were similarly attenuated.
The authors concluded that “systemic corticosteroid exposure was the predominant driver of this increased risk,” emphasizing the importance of targeted prevention strategies.
Reference
Eldesouki M, Youssef M, Ibrahim MA. Increased risk of respiratory syncytial virus infection and severe outcomes in patients with active inflammatory bowel disease: a matched cohort study. Presented at: Digestive Disease Week; May 2–5, 2026; Chicago, Illinois.
