Increased incidence of systemic serious viral infections in patients with inflammatory bowel disease associates with active disease and use of thiopurines

Abstract

Background The magnitude and drivers of the risk of serious viral infections in Inflammatory Bowel diseases (IBD) are unclear. Objective The objective of this study was to assess the incidence and risk factors for systemic serious viral infections in IBD patients. Methods Using MICISTA, a database detailing prospective characteristics and complications of IBD, we identified patients that were followed for IBD in 2005–2014 outside the context of organ transplantation, HIV infection or chronic viral hepatitis. We estimated incidences of systemic serious viral infections, defined by the need for hospitalization or permanent organ damage. Standardized incidence ratios (SIRs) were calculated using the French hospital database. We performed a case-control study nested in MICISTA for assessing the role of exposure to IBD drugs and IBD clinical activity in the risk of developing infection. Results We identified 31 patients with serious viral infections among 2645 patients followed for 15,383 person-years. We observed 13 cases of cytomegalovirus, 10 Epstein–Barr virus, 5 varicella zoster virus and 3 herpes simplex virus infections. No deaths occurred. The incidence rate of infections in patients with IBD was 2.02/1000 person-years, and the SIR was 3.09 (95% confidence interval (CI), 1.98–4.20; p = 0.0002) in the study population. By multivariate analysis, increased risk of infection was associated with exposure to thiopurines (odds ratio (OR), 3.48; 95% CI, 1.36–8.90; p = 0.009), and clinically active IBD at onset of infection (OR, 3.35; 95% CI, 1.23–9.23; p = 0.02). Conclusions The incidence of systemic serious viral infections in patients with IBD is tripled compared to general population. Clinically active IBD and exposure to thiopurines are the main drivers of the risk.

2019 novel coronavirus disease (COVID‐19) in patients with inflammatory bowel diseases

“…14 In a large study, thiopurines but not biologics were associated with serious viral infections related to EBV, CMV, VZV and HSV infection. 5 A meta-analysis of clinical trial data including 4135 patients given anti-tumour necrosis factor (TNF) therapy found that the relative risk of developing an opportunistic infection, including severe viral infections, was significantly increased in the anti-TNF arm. 30 33 Therefore, given the lack of effectiveness and possible harm, routine corticosteroids should be avoided unless they are indicated for another reason, according to WHO interim guidance.…”

“…These patients may have a greater risk of acquisition or progression of serious viral infections, including COVID-19. 5 However, the initial available evidence suggests that IBD patients do not have an increased risk of contracting SARS-CoV-2 infection or development of COVID-19, since no patients have been reported to be infected with SARS-CoV-2 in IBD centres in China. 6 Moreover, a recent study reported that none of the patients with IBD followed at a tertiary referral centre in Italy developed To date, there are limited data on patients with IBD who have had COVID-19.…”

Management of IBD during the COVID-19 outbreak: resetting clinical priorities

“…However, a study in a tertiary care population of 2,600 patients with IBD followed for >15,000 patient-years described an exhaustive characterization and validation (hospitalization reports) of all serious viral infections (for example, all that required hospitalization) including varicella zoster virus (VZV), herpes simplex virus (HSV), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) but not SARS-CoV-2 (ref. 7 ). The follow-up included >3,800 patient-years of exposure Management of IBD during the COVID-19 outbreak: resetting clinical priorities Silvio Danese 1,2 ✉ , Maurizio Cecconi 2,3 and Antonino Spinelli 2,4 The coronavirus disease (COVID-19) worldwide outbreak has led to a dramatic challenge for all healthcare systems, including inflammatory bowel disease (IBD) centres.…”

Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance

“…Previous studies have demonstrated that clinically active IBD and exposure to thiopurines increase the risk of viral infections (16,17). However, unlike other viruses (Influenza, Herpes, Cytomegalovirus, Adenovirus, Rhinovirus, Norovirus, and Respiratory Syncytial Virus), coronaviruses have not been shown to cause more severe disease in immunosuppressed patients (13,15,17).…”