Using Swedish nationwide registers (2007–2024), this study assessed serious infection risk in IBD patients across therapy classes (immunomodulators, TNF inhibitors, anti-integrins, anti-interleukins, JAK inhibitors) with vs. without concomitant corticosteroids, compared to matched general population controls (up to 10:1) and via 1:1 propensity score-matched within-therapy comparisons.
Corticosteroid use was consistently associated with higher serious infection rates across all therapy groups vs. non-corticosteroid periods: incidence rate differences of 3.6–10.2/100 person-years vs. general population (aHR 4.52–15.86) and 3.9–8.5/100 person-years in PS-matched within-therapy comparisons (aHR 1.82–3.60); relative risk was highest in children and rose with cumulative corticosteroid dose.
Observational register-based design limits causal inference; corticosteroid use may be a marker of disease severity (confounding by indication), which PS-matching only partially addresses; specific infection types and corticosteroid regimens (dose, duration, route) are not individually reported.
Clinicians should treat corticosteroid exposure in IBD as an independent, dose-dependent driver of serious infection risk—regardless of the concomitant advanced therapy used. Minimizing corticosteroid burden and prioritizing steroid-sparing strategies, especially in children, should be central to infection-prevention planning.
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