P579 Risk of CMV reactivation in UC patients with previous history of CMV infection following infliximab or vedolizumab treatments

Abstract

Background: Cytomegalovirus (CMV) persists in the colonic mucosa throughout the lifetime of infected subjects and reactivation with viral replication can occur especially in case of immunosuppression. Anti‐integrin drugs, while depleting the intestine of circulating lymphocyte, may favour CMV reactivation due to diminished constant immune surveillance. The aim was to compare in UC patients with prior CMV immunisation the risk of CMV reactivation and colectomy rates on vedolizumab (VZ) compared with infliximab (IFX). Secondary aims were to identify risk factors for CMV reactivation and characterise CMV reactivation in both groups. Methods: In a single tertiary centre, UC patients with CMV IgG seropositivity prior to intravenous treatment with VZ or IFX were evaluated clinically and endoscopically. Patients with the absence of CMV replication prior to treatment, assessed by quantitative PCR for CMV DNA load, were included. Primary endpoint was CMV reactivation with colitis detected by tissue colonic PCR. Results: Between January 2008 and September 2016, 33 patients with positive CMV IgG but no signs of active CMV colitis started either VZ (n = 16) or IFX (n = 17). Baseline characteristics of patients, concomitant treatments and endoscopic disease severity were similar in both groups except for prior lines of treatments, disease extension and duration which were higher in the VZ group. CMV colitis reactivation occurred in 10 patients (median time: 5.9 months (VZ) and 2.5 months (IFX)). Incidence rates of CMV colitis were 5 of 14.2 patient‐years in the VZ group compared with 5 of 54.4 patient‐years in the IFX group. Using a Cox model and correcting for disease severity (assessed by endoscopic and total Mayo score), our data support an increased risk of CMV reactivation in patients treated with VZ (HR [95 CI]: 2.3 [0.5‐9.3]) compared with IFX and in case of concomitant steroid use (HR [95 CI]: 5.1 [0.6‐41]). During CMV reactivation, clinical, endoscopic and biological severity were higher in the VZ group. Quantification of tissue CMV replication levels were heterogeneous in both groups but median tissue viral load was higher in the IFX group (6482 IU/100,000 cells [iQR 263‐6945] vs. 225 [iQR 77‐961]). Colectomy was observed in three VZ patients (two with reactivated CMV) but not in IFX patients. Conclusions: In UC patients, seropositive for CMV, our data support a higher risk of CMV reactivation when treated with VZ compared with IFX. CMV reactivation was clinically and endoscopically more severe in patients treated with VZ. Whether this is reflecting a negative effect of VZ or the consequence of uncontrolled disease is unknown. CMV reactivation and the risk for colectomy in patients under VZ warrants further investigation. Downloaded from.