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P351. Screening for opportunistic infection prior to initiating immunomodulator therapy in IBD patients - Practice in the North East of England

S. Nair, D. Hobday, Sunderland Royal Hospital, Gastroenterology, Sunderland, United Kingdom

Background

Screening for opportunistic infections prior to initiating immunomodulator therapy in IBD patients is crucial and a guideline has been published by the European Crohn's and Colitis Organisation (ECCO) [1]. This recommends screening for infections including hepatitis B (Hep B), tuberculosis (TB), HIV and varicella zoster virus (VZV), together with vaccinations against influenza and pneumococcal and in women, gynaecological screening with cervical smears and HPV vaccination. The aim of the study was to determine the level of ECCO guideline adherence among clinicians in the North East of England.

Methods

An anonymised web-based survey was conducted in June 2013. This was sent to gastroenterology clinicians in the North East of England who are responsible for initiating immunomodulator therapy. The survey included questions on: (1) awareness of ECCO guidance, together with adherence to (2) infection screening, (3) vaccination recommendations and (4) gynaecological screening.

Results

Fifty responses were received and analysed, of these 42% were aware of the ECCO guideline and their content, 42% were aware of the guideline but not their content and 16% were unaware of the guideline.

Rates of screening were found to be low prior to initiating Azathioprine (AZA), 6-Mercaptopurine (6-MP) and Methotrexate varying from 8% to 54%, compared to overall higher rates of screening varying from 8% to 90% prior to commencing anti-TNF therapy.

Figure: Clinician adherence to screening prior to commencing (A) AZA/6-MP, (B) methotrexate and (C) anti-TNF therapy.

Conclusion

Immunomodulatory therapy has revolutionised the treatment of IBD but at the potential risk of increased opportunistic infections. Our study demonstrates a need for greater awareness and implementation of the ECCO guideline among clinicians responsible for prescribing immunomodulators in IBD patients.

1. Rahier JF, et al. (2009), European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease, Journal of Crohn's and Colitis.