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Epstein-Barr Virus Status and Subsequent Thiopurine Exposure Within a Paediatric Inflammatory Bowel Disease
Rachel E Harris1, Vikas Hegde2, Lee Curtis3
1Department of Paediatrics, Sheffield Children's Hospital, Sheffield.
Insights
Thiopurine therapy in Epstein-Barr virus (EBV)-naïve pediatric inflammatory bowel disease (IBD) patients is common. While EBV reactivation occurred in some, serious complications were not observed, suggesting careful risk-benefit assessment.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Infectious Diseases
Background:
- Thiopurine therapy is frequently used for pediatric inflammatory bowel disease (IBD).
- Concerns exist regarding Epstein-Barr virus (EBV) reactivation and associated complications in EBV-naïve patients on thiopurines.
- Evaluating EBV status and outcomes in this population is crucial for treatment decisions.
Purpose of the Study:
- To assess Epstein-Barr virus (EBV) serostatus at diagnosis in pediatric IBD patients.
- To evaluate the incidence of EBV reactivation and associated complications in EBV-naïve IBD patients receiving thiopurine therapy.
- To determine the proportion of patients who would be excluded from thiopurine therapy based on EBV status.
Main Methods:
- Retrospective analysis of pediatric IBD patients over an 8-year period.
- Screening for EBV seropositivity at diagnosis.
- Monitoring for EBV reactivation and clinical outcomes, including complications.
- Analysis of thiopurine use in relation to EBV status.
Main Results:
- 53% of 409 screened pediatric IBD patients were EBV seropositive at diagnosis.
- Thiopurines were used in 87% of EBV-seropositive and 83% of EBV-seronegative patients.
- 4% of previously EBV-seronegative patients developed EBV positivity, with 86% concurrently on thiopurines; no serious complications were noted.
Conclusions:
- A significant percentage of pediatric IBD patients are EBV seropositive at diagnosis.
- While EBV reactivation can occur in EBV-naïve patients on thiopurines, serious complications were not observed in this cohort.
- The decision to use thiopurine therapy in EBV-naïve IBD patients requires balancing the risks of EBV complications against the benefits of IBD management.
Abstract:
The use of thiopurine therapy in Epstein-Barr virus (EBV)-naïve inflammatory bowel disease (IBD) patients remains controversial due to a risk of EBV-associated complications. We evaluated EBV status and outcomes within our paediatric IBD population over an 8-year period; finding that 217 of 409 (53%) screened patients were seropositive for EBV at IBD diagnosis; that thiopurines were used in 189 of 217 (87%) seropositive and 159 of 192 (83%) seronegative patients (P = 0.22); and that 7 of 192 (4%) previously seronegative patients subsequently tested positive for EBV with 6 of 7 (86%) patients having concurrently recorded thiopurine use. All six patients continued thiopurine with/without a period of cessation; no EBV-associated lymphoproliferative disorders/serious complications were recorded within our cohort. A significant proportion of our patients would not receive thiopurine therapy should their use be avoided in EBV-negative patients (47%) or seronegative males (30%). The small but significant risks of thiopurine treatment must be balanced against the potential benefits of successful IBD management; further research into this is required.
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