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P400. Opportunistic infections in anti-TNF treated IBD patients: analysis from three tertiary centers in Romania

R.B. Mateescu1, R. Vadan2,3, L. Negreanu4, A. Bengus5, R. Dinu5, B. Busuioc5, B. Cotruta3, M. Diculescu2,6, C. Gheorghe2,6, L. Gheorghe2,6, 1UMF Carol Davila, Bucharest; Colentina Clinical Hospital, Gastroenterology Dept, Bucharest, Romania, 2Fundeni Clinical Institute, Digestive Diseases and Liver Transplantation Center, Bucharest, Romania, 3Centrul de Gastroenterologie si Hepatologie Fundeni, Gastroenterology Dept, Bucharest, Romania, 4UMF Carol Davila, Bucharest; University Hospital, Internal Medicine 2, Bucharest, Romania, 5Colentina Clinical Hospital, Gastroenterology, Bucharest, Romania, 6UMF Carol Davila, Bucharest; Centrul de Gastroenterologie si Hepatologie Fundeni, Gastroenterology Dept, Bucharest, Romania

Background

Anti-TNF agents, together with the classic immunosuppressors, are the mainstay of treatment in IBD; deriving from their action mechanism, there is an increased risk for infection and malignancy. Because Romania is a high prevalence country for tuberculosis (even if the exact incidence of latent tuberculosis is not known), the standard procedure for immunosuppressive treatment initiation in Romania includes screening for hepatitis B virus, hepatitis C virus, HIV, and tuberculosis. Even though, we are facing a number of opportunistic infections in these patients. This is why we intended to evaluate the safety of the immunosuppressor treatment, in general, and of anti-TNF agents, in particular, in Romanian patients with IBD.

Methods

We performed a retrospective analysis of 113 consecutive patients with moderate to severe ulcerative colitis and Crohn's disease admitted to three tertiary centers in Bucharest between 2009–2013, who received anti-TNF agents (infliximabum or adalimumabum) with/without classic immunosuppressors (azathioprine, methotrexate or 6 mercaptopurine) associated; we intended to determine the incidence of opportunistic infections and the possible risk factors.

Results

We analyzed 113 patients - 82 (72%) with Crohn's disease and 32 (28%) with moderate to severe ulcerative colitis. We found 27 opportunistic infections: 5 cases of Clostridium difficile infection (4.5%), 2 cases of CMV colitis (1.8%), 2 cases of TB reactivation (1.8%) - 1 peritoneal TB and one intestinal TB and 2 cases of perianal abscesses (in patients with ulcerative colitis), 3 (2.7%) cases of herpes zoster and 16 (14.1%) cases of upper respiratory tract and urinary tract infections. All patients were treated according to the guidelines, severe infections being admitted to the hospital and resolved with treatment; none of the patients had complications and there were no deaths. 17.5% of the patients had latent TB and received standard chemoprophylaxis before antiTNF (including those with intraabdominal TB).

Conclusion

The association between anti TNF agents and classic immunosuppressors increased the risk of infection. The risk of TB reactivation was significant, even with a correct chemoprophylaxis. The duration of immunosuppressor therapy did not influence the rate of infection.