Specific clinical features present in patients with inflammatory bowel disease can significantly increase their risks for developing cytomegalovirus (CMV) disease, according to a study published in Clinical Gastroenterology and Hepatology (doi:10.1016/j.cgh.2014.05.026).
Inflammatory bowel disease (IBD) “is an ideal condition for viral reactivation because of the frequent use of immunosuppressive therapy and the virus’s tropism for inflamed mucosa. The association appears greatest with ulcerative colitis (UC) refractory to corticosteroids (CS) but has also been reported with Crohn’s disease (CD),” wrote Dr. Jeffrey D. McCurdy of the Mayo Clinic, Rochester, Minn., and his coauthors.
In a retrospective, case-controlled study, the investigators examined 1,111 patients between January 2005 and December 2011. Among these patients, 68 (6% of original population) were diagnosed with cytomegalovirus (CMV) disease; 66% (45 patients) had ulcerative colitis, 31% (21 patients) had Crohn’s disease, and 3% (2 patients) were diagnosed with unclassified IBD. Each of these patients were matched to 3 other subjects diagnosed with IBD and suspected CMV disease, who represented the study’s controls.
Patients were classified into groups of initial IBD assessment, symptomatic disease without therapeutic escalation, refractory disease, or “other,” which was used for subjects with “inadequate records, minimal clinical symptoms but moderate or severe endoscopic disease, or patients who did not meet the criteria for refractory disease.” Refractory disease classifications were for subjects who displayed little to no improvement in symptoms after 14 days of oral corticosteroids (CS), 7 days of intravenous CS, 2 induction doses of a tumor necrosis factor (TNF) antagonist, or escalated dosing of a TNF antagonist.
Preset clinical and endoscopic definitions were used to score each of the subjects. Medication exposure for TNF antagonists was considered positive if taken within 2 months of CMV disease diagnosis, and considered positive for methotrexate, thiopurines, (CS), and mesalamine when taken within 1 month. Investigators also grouped thiopurines and methotrexate together as immunomodulators (IM) for the purposes of simplifying data analysis.
The authors found that subjects with medically refractory IBD (odds ratio [OR], 3.69; P < .001) or endoscopic ulcers (OR, 3.06; P < .001), and those who received CS (OR, 2.95; P < .001) or IM (OR, 1.86; P = .030) – but did not receive TNF antagonists (OR, 1.30; P = .376) – were more likely to have CMV disease than were patients who had IBD but did not have these other clinical features. Investigators also ran a multivariable model, which showed that refractory disease classification, treatment with IM, and age greater than 30 were “independently associated with CMV disease.”
“The current risk model should help modify the current recommendations that apply only to hospitalized patients with acute, severe UC by reducing unnecessary, invasive testing in hospitalized patients and identifying high-risk ambulatory patients who may not have otherwise been considered for testing,” the authors wrote.
Dr. McCurdy and his coauthors reported no financial disclosures.