Letter: screening for infectious side effects in patients with IBD—the importance and potential of real‐world remote monitoring

EDITORS, We read with interest the study by Khan et al regarding the incidence and impact of IBD medications on risk of pneumonia and pneumoniarelated hospitalisation.1 We compliment the authors for their effort to address the paucity of data on infections such as pneumonia in the IBD population. Using the nationwide Veterans Affairs database, they found incidence rates of 6.47 and 2.52 per 1000 personyears (PY) for pneumonia and pneumoniarelated hospitalisations, respectively. The strict definition for pneumonia events in their study has ensured the inclusion of clinically relevant cases ( i.e., more severe cases) of pneumonia, but may have led to underreporting of milder infectious events. The choice to include a positive chest Xray in their definition might also have led to variable sensitivity rates.2 Although mildtomoderate lower respiratory tract infections (LRTIs) are generally associated with low morbidity and mortality rates, they can have negative effects on patients' quality of life and perceived health, lead to increased healthcare costs and decreased societal participation. Reporting differences in all infections is important when addressing the real burden of treatment options in IBD. To add further insight on the prevalence of these infections, we share our realworld multicentre experience with the IBD population in South Limburg based on data collected using myIBDcoach, an established telemedicine platform for IBD management, which contains several patientreported outcome measures and remote monitoring tools, including periodic assessment of infectious events.3 In 600 IBD patients (mean age at cohort entry 49.7 [SD 14.9]; n = 342 Crohn’s disease [59.9% female]; n = 258 ulcerative colitis [47.7% female]), included between 1 January 2020 and 1 January 2021, we observed 43 LRTIs during followup (including pneumonia, excluding COVID19). Of these, 16 were mild (i.e., either requiring no treatment or analgesics), 25 moderate (i.e., requiring oral antibiotics) and two severe ( i.e., hospitalisation or intravenous antibiotics), corresponding to incidence rates of 2.5, 4.0 and 0.3 per 100 PY, respectively (Table 1). All events were crosschecked with GP and pharmacy data, and no LRTIrelated deaths were observed. Representativeness of this subset of patients for the realworld situation was established by comparing demographics (age, sex, smoking) and clinical characteristics (Montreal classification) to the total IBD population in SouthLimburg.4 We acknowledge the smaller sample size when compared to the study of Khan et al and understand that their study design did not allow for capturing milder infections. However, the rates observed in our study, especially for moderate infections (requiring antibiotics), are substantially higher than those observed by Khan et al, which cannot only be explained by potential other causes of LRTIs in our cohort. Data on mild and moderate infections in medically treated IBD patients remain scarce and the most plausible explanation is that events treated by general practitioners are not systematically captured in surveillance registries. Our data particularly underscore that, in a realworld population of IBD patients, a substantial proportion of LRTIs follow a mildtomoderate course. Remote monitoring tools designed to periodically assess infectious events could overcome the paucity of data regarding mild and moderate infections.