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Young patients with inflammatory bowel disease (IBD) are five times more likely than the general population to develop viral infections that can lead to hospitalisation or permanent organ damage, a new study suggested.
For the study, published in the journal United European Gastroenterology Journal, researchers analysed almost 2,700 IBD patients in a Paris referral centre to understand the respective roles of IBD activity and drugs in promoting systemic serious viral infection (SVI).
The study identified clinically active IBD and thiopurines (a class of immunomodulators used to treat an estimated 60 per cent of IBD patients) as the main drivers of infection.
Despite the highest risk of infection being seen in young patients between the ages of 18 and 35, a three-fold increased incidence of severe viral infections was observed in IBD patients of all ages.
"The relation between IBD drugs and SVIs is especially concerning, as presently, hospitalisation due to the serious complications that accompany the disease is the main cost associated with the management of IBD," said study lead researcher Laurent Beaugerie, Professor at Saint-Antoine Hospital in France.
"The growing prevalence of IBD across the globe will only add further to the pressure placed on healthcare structures," Beaugerie added.
The study also uncovered a concerning link between thiopurine use and a number of harmful infections.
Whilst IBD patients receiving no treatment were at a similar risk level to the general population, patients treated with immunomodulators were found to be six times more likely to develop an SVI.
The most common SVIs developed by IBD patients were identified as Epstein-Barr virus (EBV), which is associated with a range of diseases such as glandular fever and Hodgkin's Lymphoma, and cytomegalovirus (CMV), an infection which can pose a risk to unborn babies.
A correlation was also found between thiopurine use and EBV-induced hemophagocytic lymphohistiocytosis (HLH), an aggressive disease associated with high mortality rates.
With a third of patients estimated to be stopping thiopurine use due to adverse side effects, these new findings underline the need to find novel therapeutic approaches to tackle IBD.
"Clinicians need to be aware of the substantially increased risk of SVI in patients with IBD, which had previously remained unclear," the professor said.
"Young IBD patients are the most vulnerable to the development of SVIs, as they are less likely to have been exposed to viruses such as Epstein-Barr virus (EBV) or cytomegalovirus (CMV) before," Beaugerie said.
"They will therefore mount a less effective immune response. Their risk is further elevated by the inhibiting effect of the immunosuppressive drugs they are treated with," Beaugerie added.