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Background

Patients with Inflammatory Bowel Disease (IBD) are often treated with long-term biologic therapies to achieve and maintain remission. Biologic therapies are more selective than steroid therapies, which affect the body systemically and produce major side effects, as they are tailored to inhibit specific proteins to help suppress inflammation. A common target for IBD biologic agents is tumor necrosis factor alpha (TNF-alpha) that is involved with inflammation in the intestines. Biologic therapies can be self-injected, such as Adalimumab, or administered through an IV infusion by professional healthcare providers, such as Infliximab. Long-term use of these biologics, however, can subject patients to vaccine-preventable illnesses. Current guidelines regarding Hepatitis C virus (HCV) screening before starting biologic therapy are unclear, but are deemed appropriate and supported in existing clinical practices. Our study aim was to evaluate the impact of the type of biologic agent administration on the receipt of HCV screening among IBD patients.

Methods

Using electronic health records, we performed a retrospective review of IBD patients at an academic medical center over 6 months to evaluate the administration of HCV screening between self-injection and IV infusion biologic therapies. All IBD patients were under the care of faculty gastroenterologists. Data regarding demographics, vaccination status, and biologic agents were compiled into a database while maintaining subject confidentiality. Statistical analysis was conducted using a 2-tailed Fisher's Exact Test with a significance set at P < 0.05.

Results

Out of 103 total patients on biologic therapies, 60 (58%) had received HCV screening. Among the 61 (59%) patients on IV infusion biologic therapies, 45 (69%) received HCV screening. Among the 42 (41%) patients on self-injected biologic therapies, 18 (43%) received HCV screening. There is a 1.6-fold absolute increase in HCV screening among IBD patients on IV infusion compared to self-injected biologic therapies (P = 0.014).

Conclusions

Our data indicate that IBD patients on IV infusion biologic therapies receive significantly more HCV screening than those on self-injectable biologic agents. It is important to screen for HCV prior to anti-TNF therapy as there is an increased risk for reactivation and induction of autoantibodies. Anti-TNF therapy has also been observed to promote the development of HCV-associated mixed cryoglobulinemia, likely as a complication from HCV reactivation. HCV may lead to cirrhosis, hepatocellular carcinoma, or liver failure, and is the most common cause of liver transplants in the US. Our study highlights the need to increase screening for HCV among IBD patients initiating biologic therapies, especially among those starting self-injectable agents. With increased screening, the morbidity and mortality related to HCV reactivation will hopefully be reduced.

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Copyright © 2017 Crohn's & Colitis Foundation of America, Inc.
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