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P138. The prevalence of vitamin D deficiency in adult patients with Crohn's disease on anti-TNF alpha therapy: report from a large UK teaching hospital

H. Woodland1, E. Arthurs1, A. Fraser1, J. Tyrrell-Price1, T. Creed1, 1University Hospital Bristol, Gastroenterology, Bristol, United Kingdom

Background

Vitamin D deficiency causing osteomalacia in patients with inflammatory bowel disease (IBD) should be sought and treated according to the British Society of Gastroenterology (BSG) guidelines [1]. There is increasing data implicating vitamin D as a key regulator in immune function, and deficiency may lead to the development of various immune disorders including IBD. Vitamin D deficiency has also been associated with severity of disease activity and poor quality of life [2]. The aim was to determine the prevalence of 25-hydroxy vitamin D (25-(OH)D) deficiency in patients with CD commenced on anti-tumour necrosis factor alpha therapy in our IBD patient cohort.

Methods

Data was gathered as part of the NICE Technology Appraisal review [3]. Patients with CD commenced on anti-TNF alpha therapy between 1st March 2010 and 29th February 2012 were identified from our patient database. Cases were verified by paper records. Evidence of measurement of serum 25-(OH)D by tandem mass spectrometry in selected patients was identified from the trust pathology database. Data regarding therapy and serum 25-(OH)D was collected and analysed. 25-(OH)D levels of <25 nmol/L were classed as severe deficiency; 25–50 nmol/L deficiency, 50–75 nmol/L sub-optimal, and >75 nmol/L adequate levels.

Results

Sixty-five patients were commenced on anti-TNF alpha therapy during this time period. Serum concentrations 25-(OH)D had been measured in thirty-eight patients, twenty-four were on infliximab, fourteen were on adalimumab. Twenty-two patients (57.9%) had evidence of severe 25-(OH)D deficiency (<25 nmol/L); eleven patients (28.9%) showed serum levels consistent with deficiency (25–50 nmol/L); four patients (10.5%) had sub-optimal levels (50–75 nmol/L) and only one patient (2.6%) was found to have adequate levels.

Conclusion

These results demonstrate that vitamin D deficiency is a significant finding amongst patients with CD on anti-TNF alpha therapy. Further work needs to be done to ascertain the effects of vitamin D deficiency on disease activity, but appropriate vitamin D screening and supplementation should be considered in patients with CD.

1. Lewis NR, Scott BB, (2007), Guidelines for osteoporosis in inflammatory bowel disease and coeliac disease, BSG.

2. Ulitsky A et al., (2011), Vitamin D deficiency in patients with inflammatory bowel disease: association with disease activity and quality of life., JPEN J Parenter Enteral Nutr., 308–16, 35(3).

3. NICE guidance, (2012), Crohn's disease – infliximab (review) and adalimumab (review of TA40) (TA187).