P319 Combining anti-inflammatory treatment with antiviral treatment in severe cytomegalovirus-positive ulcerative colitis does not affect colectomy rate: a retrospective European multicentre study
U. Kopylov*1, K. Papamichael2, 3, K. Katsanos4, M. Waterman5, A. Bar-Gil Shitrit6, T. Boysen7, F. Portela8, A. Peixoto9, A. Szilagyi10, M. Silva9, G. Maconi11, O. Har-Noy1, P. Bossuyt12, G. Mantzaris2, M. Barreiro de Acosta13, M. Chaparro14, D. Christodoulou4, R. Eliakim1, J.-F. Rahier15, F. Magro9, S. Ben-Horin16, X. Roblin17
1Sheba Medical Centre, Gastroenterology, Tel Hashomer, Israel, 2Evaggelismos Hospital, Gastroenterology, Athens, Greece, 3KU Leuven, Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), Leuven, Belgium, 4University of Ioannina, Gastroenterology, Ioannina, Greece, 5Rambam Healthcare Campus, Gastroenterology, Haifa, Israel, 6Shaare Zedek Medical Centre, Digestive diseases Institute, Jerusalem, Israel, 7Herlev University Hospital, Gastroenterology, Herlev, Denmark, 8Hospital Universidade Coimbra, Gastroenterology, Coimbra, Portugal, 9Centro Hospitalar São João, Gastroenterology, Porto, Portugal, 10Jewish General Hospital, Department of Gastroenterology, Montreal, Canada, 11Luigi Sacco’ University Hospital, Gastroenterology, Milan, Italy, 12Imelda GI clinical research Centre,, Gastroenterology, Bonheiden, Belgium, 13University Hospital of Santiago de Compostela, IBD Unit, Gastroenterology Department, Santiago de Compostela, Spain, 14Hospital Universitario de La Princesa, Gastroenterology, Madrid, Spain, 15CHU Dinant Godinne, UCL Namur, Gastroenterology, Yvoir, Belgium, 16Chaim Sheba Medical Centre, Gastroenterology, Ramat Gan, Israel, 17CHU de Saint-Etienne, Gastroenterology, Saint-Etiennne, France
Cytomegalovirus (CMV) can be frequently demonstrated in patients with ulcerative colitis (UC). ECCO guidelines recommend screening the colonic biopsies of patients treated for severe colitis for CMV with hematoxylin-eosyn (HE) staining and immunohistochemistry (IHC) for CMV; quantitative tissue polymerase chain reaction (qPCR) was also suggested. The effect of CMV infection on the outcome of CMV colitis remains unclear. Moreover, the benefit of combining antiviral with anti-inflammatory treatment has not been evaluated in the past.
The aim of the study was to compare the outcome of CMV-positive steroid resistant UC patients treated with antiviral therapy (intravenous gancyclovir) alone with the outcome of patients treated with a combination of antivirals with anti-inflammatory therapy (infliximab [IFX] or cyclosporine [CSA])
This was a multicentre retrospective study of hospitalised acute severe steroid resistant ulcerative colitis patients who had evidence of colonic CMV infection (HE/IHC or quantitative PCR). The patients were classified into 2 groups: antiviral, if treated with antiviral gancyclovir alone, and combined, if treated with both antiviral and anti-inflammatory therapy (IFX within 4 weeks or during the hospitalisation; CSA during the course of the hospitalisation). The main outcome included the rate of colectomy in both arms during the course of hospitalisation.
Included in the study were 72 patients were. CMV presence was detected by HE/IHC in 70.8% and by qPCR in 29.2% of the patients. Further, 29 (40.2%) patients were included in the antiviral group, and 43 in the combination arm (23-IFX, 15- CSA, 5- exposed to both during the hospitalisation). There was a trend for a higher rate of colectomy in the combination group that did not reach statistical significance (2/29 [6.9%] vs 9/43 [20.1%], p = 0.18). On secondary analyses, the results did not change after exclusion of patients that were treated with both CSA and IFX, had a history of anti-TNF treatment before hospitalisation or were diagnosed by qPCR. No other clinical or demographic variables were significantly associated with the risk of colectomy.
Anti-inflammatory therapy does not provide an additional risk over antiviral therapy alone in hospitalised CMV-positive steroid resistant patients for colectomy. Our findings merit validation in a large prospective study.