P829 Clostridioides difficile infection in patients using vedolizumab and antiTNF: incidence and consequences (CDIFVEDO study of GETECCU)
Authors: Gonzalez Vivo M , Font Ordeig G , López Romero-Salazar F , Camblor García C , Suarez Ferrer C , Melcarne L , de la Serna Gamboa A , Gómez Otero M , Hernández Camba A , Rubín de Célix C , Irabien M , Caballero-Mateos A M , García M J , Pérez Santamaria C , Vázquez García P , Castro Poceiro J , Moralejo Lozano O , Rodríguez Grau M C , Pérez Galindo P , Iglesias Doallo A , Jiménez García N , Ruiz-Rodríguez J , Teller Martin M , Riera Roig J , Marquez-Mosquera L , Benítez J M , Zabana Y , Gutiérrez A 
Published: January 2024

Abstract

Background
Clostridioides difficile infection (CDI) is a frequent cause of flares in inflammatory bowel disease (IBD) and it is related to higher risk of colectomy and mortality. The incidence of CDI in IBD is higher than in the general population and it has increased in recent years. Biologic therapy could be risk factor for CDI, but the evidence is scarce.
The aim of the study was to compare CDI incidence between IBD patients treated with anti-tumor necrosis factor (antiTNF) agents and VDZ. Secondary endpoints were outcomes related to CDI (hospital admission, intensive care monitoring, colectomy) and IBD (steroids requirement, switch of biologic therapy, surgery).

Methods
Retrospective observational multicenter study conducted in 23 Spanish hospitals, promoted by GETECCU, including patients with ulcerative colitis or Crohn’s disease with colonic involvement who had CDI after complete induction of antiTNF (group 1) or VDZ (group 2) between 2018 and 2021. Hospitals also provided the total number of patients who initiated antiTNF or VDZ during that period.
The chi-square test was used to compare categorical variables, and the Mann–Whitney U-test to compare quantitative variables.

Results
A total of 3860 IBD patients with antiTNF treatment and 780 with VDZ were reviewed. 63 patients with CDI were identified: 45 in group 1 and 18 in group 2. Incidence of CDI was statistically higher in group 2 than in group 1 (2.3% vs 1.2% respectively; p=0.01). Baseline characteristics of patients with CDI in both groups are shown in Table 1. Risk factors for CDI (chronic kidney failure, hospitalization, previous antibiotic usage, previous CDI) were distributed similarly between groups, except proton pump inhibitor treatment (35.6% in group 1 vs 76.5% in group 2; p=0.01).
No significant differences in the evolution of CDI were found between groups. Hospital admission rate was 53.3% in group 1 and 27.8% in group 2 (p=0.09). None required intensive care or colectomy caused by CDI. Recurrent CDI (within 8 weeks) occurred in 8.9% in group 1 and 11.1% in group 2 (p=0.79).
Outcomes of IBD were similar between groups, regarding steroid treatment (51.1% in group 1 vs 50% in group 2; p=0.94) and switch of biologic therapy (37.8% in group 1 vs 50% in group 2; p=0.37). During follow-up, there was 1 case (group 1) of perforation in the 1st month and 5 patients (4 in group 1; 1 in group 2) required surgery for medically refractory disease between the 3rd and 6th month. One patient (group 1) died (non-IBD or CDI-related cause).

Conclusion
Incidence of CDI was higher during VDZ therapy compared with antiTNF. The evolution of CDI and IBD tends to be similar between groups. More data are needed to consider VDZ as a risk factor of CDI.