TBA (16S142)

Opportunistic infections in Inflammatory Bowel Disease: Opportunity gained or lost?

Author(s)

Grace Harkin, Rahim Khan, Aoife Murray, Andrew Smyth, Áine Keogh, Laurence Egan, Eoin Slattery

Department(s)/Institutions

Gastroenterology Department, University Hospital Galway

Introduction

The potential for opportunistic infections (OI) remains a key safety concern for patients with inflammatory bowel disease (IBD). They can be associated with considerable morbidity and mortality. As a result, ECCO produced guidelines on appropriate screening for patients prior to biologic therapies in 2014.

Aims/Background

To assess the quality of screening for OI in patients with IBD attending a busy tertiary referral hospital since the advent of published guidelines. A secondary aim was to assess the uptake of vaccination for OI.

Method

We performed a retrospective cohort study of patients attending Galway University Hospitals currently receiving a biologic agent. Identified patient’s records were interrogated.

Results

Of 158 patients (83 male) currently receiving biologic therapy, 74.7% (n=118) have Crohn’s Disease (CD). Agents included Infliximab in 53.5% (n=84), Adalimumab in 34.3% (n=54), Vedolizumab in 7% (n=11) and Golimumab in 5.1% (n=8). Combination immuno-modulators were prescribed in 44.2%. Screening was completed for Hepatitis C (HCV) in 67.5% (n=104), Hepatitis B (HBV) in 70.1% (n=108), Human Immunodeficiency Virus (HIV) in 64.0% (n=98) and Varicella Zoster Virus (VZV) in 49% (n=74). Overall, 44.3% (n=70) had a complete viral screen (HBV, HCV, HIV and VZV) in advance of biologic therapy. Complete screens were completed in 25.0% (n=18) of patients commencing biologic therapy before 2014, compared to 60.5% (n=52) of patients commencing biologic therapy since 2014 (p<0.001). One patient had a positive HCV result; all patients had negative results for HBV and HIV; only three screened patients were non-immune to VZV. Of the non-immune VZV patients, one was vaccinated, one was not and the vaccination status of the third patient was not established. No patients were vaccinated against HBV.

Conclusions

ECCO guidelines recommend screening for HBV and VZV prior to initiation of biologic therapies; and where negative vaccination is advocated. A significant increase in screening for OI has occurred in our institution as a consequence of published guidelines. In low prevalence areas of HBV, the benefit of routine vaccination is questionable. Timing of VZV vaccination remains problematic. Our data confirms that published guidelines are an important trigger in improvement of care provided to patients with IBD.