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Poster presentations: Clinical: Therapy and Observation 2020

P459 The impact of latent cytomegalovirus infection on the disease behaviour in patients with ulcerative colitis

P. Långvall1, C. Shi1, P. Karling2

1Department of Public Health and Clinical Medicine- Umeå University, Medicine, Umeå, Sweden, 2Department of Public Health and Clinical Medicine- Umeå University, Norrlands University Hospital NUS Umeå, Umeå, Sweden

Background

Cytomegalovirus (CMV) infection has been associated with steroid-refractory disease and risk for colectomy in patients with Ulcerative Colitis (UC). We aimed to study if patients with latent CMV infection more often needed systemic steroids, immunomodulators, biologics and surgery than patients negative for CMV infection.

Methods

From the national IBD register (SWIBREG) all patients with UC (n = 404) treated at Umeå University Hospital in Sweden, and who were tested for CMV infection were included. A latent CMV infection was defined if a patient had at least one positive serology and/or a positive PCR for CMV. A retrospectively medical chart review between the years 2006 and 2019 was performed to check for medical therapy and surgery due to UC.

Results

One hundred and thirty-one patients (32%) had at least on one occasion been tested for CMV infection and of these patients, 88 (67%) had evidence of a latent CMV infection. There were no differences in the use of systemic steroids, in the use of immunomodulators/biologics or in colectomy rate between patients with latent CMV infection and patients with no infection (table). There were no differences between patients with latent CMV infection vs. no infection in median faecal calprotectin (FC) levels the first five years after diagnosis (302 vs. 457 µg/g; p = 0.301) or at the last recorded FC test (62 vs. 82 µg/g; p = 0.317).

Latent CMV infection (n = 88)No CMV infection (n = 43)p-value
Mean age years (SD)42.3 (9.2)40.4 (7.8)0.246
Female gender43% (n = 38)49% (n = 21)0.541
Montreal classification
A116% (n = 14)19% (n = 8)0.913
A279% (n = 69)76% (n = 32
A35% (n = 4)5% (n = 2)
E113% (n = 11)7% (n = 3)0.378
E219% (n = 17)23% (n = 10)
E368% (n = 60)70% (n = 30)
Medical treatment (ever)
Five-ASA95% (n = 84)95% (n = 41)0.978
Thiopurines56% (n = 49)60% (n = 26)0.603
Anti-TNF26% (n = 23)26% (n = 11)0.946
Vedoluzimab3% (n = 3)2% (n = 1)>0.999
Median numbers of courses with systemic steroids (25th-75th percentile)1.5 (0–4.0)2.0 (0–3.5)0.950
Colectomy12% (n = 11)9% (n = 4)0.772

Conclusion

Patients with latent CMV infection do not differ from CMV negative patients in the use of medical therapy for UC nor in colectomy rate.