PWE-001 Effects of EBV naive status on treatment decisions in IBD

Abstract

Introduction Thiopurines, through an association with Epstein Barr Virus (EBV), confer an increased risk of GI lymphoma when used to treat Inflammatory Bowel Disease (IBD), with EBV naive individuals carrying a higher risk. Current European Crohn’s and Colitis Organisation (ECCO) guidelines recommend considering EBV screening in individuals prior to initiating immunomodulator therapy. This audit identifies the impact of EBV naive status on subsequent treatment decisions and the resulting cost expenditure at the Royal Wolverhampton NHS Trust (RWHT). Methods We conducted a retrospective analysis of IBD patients undergoing EBV screening between June 2015 and June 2017 and extracted relevant data from electronic records. Results Overall 359 patients underwent EBV screening in the specified period with 43 (12%) patients being identified as EBV naive. The EBV naive sample consisted of 27 (63%) males and 16 (37%) females, with a mean age of 40. Of these 43 patients, 5 were excluded from further analysis as their EBV status was tested for reasons unrelated to IBD management and 4 were excluded as their treatment was altered for reasons other than their EBV status. Table 1 shows the breakdown for the remaining 34. Table 1 Number of patients undergoing EBV screening for initial thiopurine or biologic therapy and the resulting number of patients in whom therapy was switched and the subsequent cost expenditure. *Calculated based on the cost of 12 months of treatment in a 70 kg individual **Patients underwent EBV screening as part of generic pre-screening bloods. Of the 13 individuals who had their therapy switched 8 (62%) were male and 10 (77%) were Caucasian. Conclusions Overall EBV naive status resulted in initiation of therapy different to the initial agent considered in 38% of patients, producing an overall cost expenditure of approximately £1 23 416 with treatment more likely to be switched in male and Caucasian patients. However, the absolute risk of lymphoma remains low and given the cost, the average age of patients being associated with poorer prognosis and increased likelihood of subsequent antibody development to biologic therapy in patients without initial thiopurine treatment, is the practise of EBV screening in IBD management clinically relevant?