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P482. Impact of cytomegalovirus reactivation treatment on inflammatory bowel disease flare

M. Delvincourt1, A. Lopez2, S. Pillet2, A. Bourrier1, P. Seksik1, J. Cosnes1, F. Carrat3, J. Gozlan4, L. Beaugerie1, X. Roblin5, L. Peyrin-Biroulet2, H. Sokol1, 1APHP St Antoine Hospital, Gastroenterology, Paris, France, 2Nancy Hospital, Gastroenterology, Nancy, France, 3APHP St Antoine Hospital, Public health, Paris, France, 4APHP St Antoine Hospital, Virology, Paris, France, 5Saint Etienne Hospital, Gastroenterology, France

Background

Consequences of the reactivation of a latent cytomegalovirus infection (CMV reactivation) on an inflammatory bowel disease (IBD) flare are debated. It is either considered as a flare-worsening factor or as a simple bystander of a severe flare. The aim of our retrospective study was to investigate the impact of antiviral treatment in patients hospitalized for IBD flare with CMV reactivation on IBD control.

Methods

105 IBD patients (23 Crohn's disease [CD], 82 ulcerative colitis [UC]) hospitalized for IBD flare with concomitant systemic CMV reactivation (PCR in blood, n = 80) and/or colonic CMV reactivation (PCR in colon biopsy, n = 28) were indentified in 3 tertiary centres. Viral load significance threshold were defined in each centre (500 to 2500 copies /mL for PCR in blood and semi-quantitative method for PCR in colon). Short term (10±4 days) and middle term evolution from CMV reactivation diagnosis was compared between patients who received antiviral treatment and those who did not. Results are shown as mean and standard deviation. Mann Whitney test, Chi2 test or logrank test were used when appropriate.

Results

Among the 80 patients with systemic CMV reactivation, no difference was observed between treated (n = 49) and untreated (n = 31) patients at inclusion regarding age, gender, IBD type, immunosuppressant, CRP level and haemoglobin level. No significant differences was observed between treated and untreated patients regarding decrease of CRP level at 10 days (11.0±49.4 vs 17.7±27.3 mg/L, p = 0.6) and colectomy rate at 3 months (10.6% vs 13.3%, p = 0.7). Antiviral treatment was associated with lower serum albumin level at inclusion (30.1±5.9 vs 26.8±4.6g/l, p = 0.03) and with a longer hospitalization (16.3±10.6 vs 8.3±5.8 days, p < 0.0001). In the severe colitis UC subpopulation (Lichtiger score ≥10), no significant difference was observed between treated and untreated patients regarding decrease of CRP level at 10 days (20.6±46.1 vs 7.0±15.2 mg/L, p = 0.4), decrease of Lichtiger score (4.1±4.7 vs 6.2±3.4, p = 0.35) or colectomy rate (logrank: p = 0.8). In the group of patients who received antiviral treatment, hospitalization was longer than in untreated patients group (15.3±8.3 vs 8.8±4.8 days, p = 0.04). Similar results were observed for colonic CMV reactivation.

Conclusion

Treatment of systemic or colonic CMV reactivation in IBD patients hospitalized for flare does not seem to impact on IBD evolution. These results should be confirmed prospectively.