From the Guidelines
Septic shock in patients with Crohn's disease taking TNF inhibitors is primarily caused by severe infections, intestinal perforation, or medication-related immunosuppression, with opportunistic infections being a significant concern due to the immunosuppressive effects of TNF inhibitors 1. The main causes of septic shock in these patients include:
- Severe gastrointestinal infections: Patients with Crohn's disease are prone to bacterial overgrowth and translocation, which can lead to systemic infection and sepsis.
- Intestinal perforation: Crohn's disease can cause bowel wall weakening, increasing the risk of perforation and subsequent peritonitis.
- Immunosuppression from TNF inhibitors: Medications like infliximab, adalimumab, or certolizumab pegol can impair the immune response to infections, as noted in the ECCO guidelines on the prevention, diagnosis, and management of infections in inflammatory bowel disease 1.
- Opportunistic infections: Due to immunosuppression, patients may develop infections from typically non-pathogenic organisms, with specific immunosuppressive medications associated with different infections, such as fungal infections with corticosteroid use, viral infections with thiopurines, and fungal and mycobacterial infections with anti-TNF agents 1.
- Abscesses: Intra-abdominal or perianal abscesses can lead to systemic infection if left untreated. To prevent septic shock, patients should:
- Maintain regular follow-ups with their gastroenterologist
- Promptly report any new symptoms or fever
- Adhere to prescribed medication regimens
- Undergo regular screening for tuberculosis and other opportunistic infections, as recommended by the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1
- Receive appropriate vaccinations before starting TNF inhibitors If septic shock is suspected, immediate medical attention is crucial, with treatment typically involving broad-spectrum antibiotics, fluid resuscitation, and possibly surgical intervention if perforation or abscess is present, and temporary discontinuation of TNF inhibitors may be necessary to allow the immune system to combat the infection effectively 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Causes of Septic Shock in Patients with Crohn's Disease Treated with TNF Inhibitors
- The use of Tumor Necrosis Factor (TNF) inhibitors, such as anti-TNF medications, in patients with Crohn's disease (CD) has been associated with an increased risk of infections, including septic shock 2.
- A retrospective study found that one patient died from septic shock 3 months after initiation of anti-TNF therapy 2.
- Another study found that 9 (2%) patients treated with infliximab and 2 (1%) of those treated with adalimumab had serious infections in years 2 and 3 of treatment 3.
- The risk of infection in patients with CD on anti-TNF treatment is higher in those with certain characteristics, such as Montreal B1 (inflammatory) behavior, and concomitant use of systemic corticosteroids 4.
- Failure to achieve mucosal healing and increased concomitant use of systemic corticosteroids are independent risk factors for infections during anti-TNF therapy 4.
Risk Factors for Infections in Patients with Crohn's Disease Treated with TNF Inhibitors
- Previous surgery has been identified as a risk factor for surgery and hospitalization in patients with CD treated with TNF inhibitors 5.
- Male sex and previous surgery are risk factors for hospitalization 5.
- Perianal fistula is a risk factor for TNF inhibitor treatment discontinuation 5.
- Patients with B1 behavior have a higher risk of developing infections than those with B3 (fistulizing) behavior 4.
- Successful corticosteroid withdrawal and mucosal healing are associated with a lower risk of infections 4.