Increased incidence of systemic serious viral infections in patients with inflammatory bowel disease associates with active disease and use of thiopurines. Issue 3 (April 2020)

• Record Type: Journal Article
• Authors: Wisniewski, Andrew; Kirchgesner, Julien; Seksik, Philippe; Landman, Cécilia; Bourrier, Anne; Nion-Larmurier, Isabelle; Marteau, Philippe; Cosnes, Jacques; Sokol, Harry; Beaugerie, Laurent
• Other Names: Arrivé Lionel non-byline-author.; Beaugerie Laurent non-byline-author.; Bourrier Anne non-byline-author.; Camus Marine non-byline-author.; Chafai Najim non-byline-author.; Chambenois Edouard non-byline-author.; Chaput Ulriikka non-byline-author.; Debove Clotilde non-byline-author.; Delattre Charlotte non-byline-author.; Dray Xavier non-byline-author.; Fléjou Jean-François non-byline-author.; Le Gall Guillaume non-byline-author.; Hoyeau Nadia non-byline-author.; Kirchgesner Julien non-byline-author.; Landman Cécilia non-byline-author.; Lefèvre Jérémie H non-byline-author.; Marteau Philippe non-byline-author.; Martineau Chloé non-byline-author.; Monnier-Cholley Laurence non-byline-author.; Nion-Larmurier Isabelle non-byline-author.; Ozenne Violaine non-byline-author.; Parc Yann non-byline-author.; Seksik Philippe non-byline-author.; Sokol Harry non-byline-author.; Svrcek Magali non-byline-author.; Tiret Emmanuel non-byline-author.
• Is Part Of: United European Gastroenterology journal. Volume 8:Issue 3(2020)
• Page Start: 303
• Page End: 313
• Publication Date: 2020-04
• Subjects: Viral infections -- immune-suppressive therapy -- thiopurines -- cytomegalovirus -- Epstein–Barr virus -- hemophagocytic lymphohistiocytosis; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640619889763
• Languages: English
• ISSNs: 2050-6406

Abstract

Background: The magnitude and drivers of the risk of serious viral infections in Inflammatory Bowel diseases (IBD) are unclear. Objective: The objective of this study was to assess the incidence and risk factors for systemic serious viral infections in IBD patients. Methods: Using MICISTA, a database detailing prospective characteristics and complications of IBD, we identified patients that were followed for IBD in 2005–2014 outside the context of organ transplantation, HIV infection or chronic viral hepatitis. We estimated incidences of systemic serious viral infections, defined by the need for hospitalization or permanent organ damage. Standardized incidence ratios (SIRs) were calculated using the French hospital database. We performed a case-control study nested in MICISTA for assessing the role of exposure to IBD drugs and IBD clinical activity in the risk of developing infection. Results: We identified 31 patients with serious viral infections among 2645 patients followed for 15, 383 person-years. We observed 13 cases of cytomegalovirus, 10 Epstein–Barr virus, 5 varicella zoster virus and 3 herpes simplex virus infections. No deaths occurred. The incidence rate of infections in patients with IBD was 2.02/1000 person-years, and the SIR was 3.09 (95% confidence interval (CI), 1.98–4.20; p = 0.0002) in the study population. By multivariate analysis, increased risk of infection was associated with exposure to thiopurines (odds ratio (OR), 3.48; 95% CI, 1.36–8.90; p = 0.009), and clinically active IBD at onset of infection (OR, 3.35; 95% CI, 1.23–9.23; p = 0.02). Conclusions: The incidence of systemic serious viral infections in patients with IBD is tripled compared to general population. Clinically active IBD and exposure to thiopurines are the main drivers of the risk.