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Cytomegalovirus, inflammatory bowel disease, and anti-TNFα

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and purpose

Anti-TNFα agents emerged in inflammatory bowel disease (IBD) as an effective option in situations that, otherwise, would be refractory to medical therapy. Cytomegalovirus infection may present with a high spectrum of manifestations and lead to high morbidity and mortality. However, its clinical significance in IBD course remains unknown and data on its association with anti-TNFα are limited.

Aims

This study aims to evaluate cytomegalovirus (CMV) infection/disease in patients with IBD treated with anti-TNFα; if possible, possible risk factors associated with CMV infection/disease in IBD patients under anti-TNFα as well as the influence of CMV infection/disease in IBD course would be determined.

Methods

During three consecutive years, all IBD patients starting infliximab in our department were included. Cytomegalovirus status before anti-TNFα was evaluated. Data regarding IBD, therapeutic and IBD course after infliximab, were recorded. CMV analysis was performed with polymerase chain reaction (PCR)-cytomegalovirus in peripheral blood and colonoscopy with biopsies (histopathology/immunohistochemistry).

Results

We included 29 patients: female—83%; Crohn’s disease–51.8%, ulcerative colitis—44.8%, non-classified colitis—3.4%; 23 cytomegalovirus seropositive. Median follow-up: 19 months (3–36). During follow-up, 14 patients were under combination therapy with azathioprine and 5 did at least 1 cycle of corticosteroids. Twenty-one patients responded to infliximab. We registered 8 exacerbations of IBD. Four patients discontinued infliximab: none had CMV infection. We documented 1 case of intestinal cytomegalovirus infection—detected in biopsies performed per protocol in an asymptomatic UC patient, who responded to valganciclovir without infliximab discontinuation.

Conclusions

Infliximab, with/without immunosuppression, does not confer an increased risk of (re)activation of cytomegalovirus. Cytomegalovirus was not responsible neither for significant morbidity nor mortality in IBD.

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Authors and Affiliations

  1. Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Praçeta Prof. Mota Pinto, 3000-075, Coimbra, Portugal

    Sara T. Campos, Francisco A. Portela & Luís Tomé

Authors
  1. Sara T. Campos
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  2. Francisco A. Portela
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  3. Luís Tomé
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Corresponding author

Correspondence to Sara T. Campos.

Ethics declarations

The proposed study protocol complies with the tenets of the Declaration of Helsinki, meets the ethical investigational principles in human subjects of the Ethics committee in our institution, and was approved by the department’s institutional review board.

Conflicts of interest

The authors declare that they have no conflict of interest.

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Campos, S.T., Portela, F.A. & Tomé, L. Cytomegalovirus, inflammatory bowel disease, and anti-TNFα. Int J Colorectal Dis 32, 645–650 (2017). https://doi.org/10.1007/s00384-017-2752-5

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