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* = Presenting author

P753 Immunosuppression for inflammatory bowel disease does not affect Epstein–Barr viral load in the short-term: preliminary results

I. Rodríguez - Lago*1, 2, O. Merino2, 3, M. J. López de Goicoechea4, M. Aranzamendi5, L. Zubiaurre2, 6, J. Ortiz de Zárate2, 7, A. Muñagorri2, 8, C. G. Cilla9, J. L. Cabriada1, 2

1Galdakao Hospital, Gastroenterology, Galdakao, Spain, 2IBD Study Group of the Basque – Navarre Society of Gastrointestinal Diseases, Pais Vasco - Navarra, Spain, 3Cruces University Hospital, Gastroenterology, Bilbao, Spain, 4Galdakao Hospital, Microbiology, Galdakao, Spain, 5Cruces University Hospital, Microbiology, Bilbao, Spain, 6Mendaro Hospital, Gastroenterology, Mendaro, Spain, 7Basurto University Hospital, Gastroenterology, Bilbao, Spain, 8Donostia Hospital, Gastroenterology, Donostia, Spain, 9Donostia Hospital, Microbiology, Donostia, Spain

Background

Inflammatory bowel disease (IBD) has been associated with a decreased quality of life, hospitalisations, and surgical interventions. Most of the available treatments have an immunomodulatory effect, which are not free of adverse effects such as infections and tumours. Epstein–Barr virus (EBV) is one example and its pathogenicity, and its potential carcinogenesis has been demonstrated in transplant recipients. We have designed a study to assess the changes of EBV viral load in naïve IBD patients starting different therapeutic regimens.

Methods

We have conducted a multicentric, prospective, observational study. We included patients with an established diagnosis of IBD, naïve to immunosuppressive therapy, who were starting thiopurine/MTX monotherapy, anti-TNF monotherapy or a combination of drugs. Baseline serological status against EBV (IgM-VCA, IgG-VCA and IgG-EBNA) and viral load were assessed. A second pre–established visit was planned 4 months after starting the treatment with a determination of the EBV viral load. The local ethics committee approved the study protocol.

Results

We have included a total of 30 patients (26% women, 45% non-smokers, age 42.7 ± 9 years) who started treatment between March and November 2015. Twenty of them suffered from Crohn’s disease, and 10 from ulcerative colitis. The most frequent indication for the immunosuppression was steroid-dependency. Twenty-six patients started monotherapy with immunomodulators (17 thiopurines and 1 methotrexate) or biologics (5 infliximab and 3 adalimumab). Four subjects received combination therapy with infliximab and thiopurines. Twenty were taking steroids at baseline. Clinical activity was scored according to Mayo index as 4.5 ± 1.6 and with Harvey–Bradshaw as 4.9 ± 2.7. The median baseline CRP was 2.8 mg/dL (IQR 1–12.1). All patients had evidence of prior exposure to EBV (positive IgG-VCA and/or IgG-EBNA) and all were negative for IgM-VCA. No patient had detectable viral load before starting the immunosuppression. In 12 patients, a second serological panel and viral load determination were performed. No patient had a detectable viral load once immunosuppression was started. One patient showed a negativisation of IgG-VCA, but IgG-EBNA was positive. No significant adverse events were detected. Only 1 patient required colectomy.

Conclusion

EBV exposure is very common in our area, with a prevalence of 100% in our cohort. No changes in the EBV viral load were observed in the short-term after the start of immunosuppression, either alone or in combination. Further studies with a greater number of patients and a longer follow-up period need to be designed to evaluate the implications of this infection and its role on clinical decisions.