RISK FACTORS FOR CYTOMEGALOVIRUS INFECTION IN PATIENTS WITH RHEUMATIC DISEASE; SINGLECENTER PROSPECTIVE COHORT STUDY
Authors: Ota Y et al., Tokyo, Japan
This study aimed to identify risk factors for CMV infections in patients with systemic rheumatic disease during intensive remission induction therapy. Consecutive systemic rheumatic disease patients who started intensive immunosuppressive therapy from February 2017 until February 2019 were enrolled. Serum CMV-IgG was measured before the induction therapy and subsequently, CMV pp65 antigen was monitored weekly.
157 patients consisting of 136 CMV-IgG positive and 21 CMV-IgG negative patients were enrolled in the study. Mean age was 61. The underlying diseases were the following; vasculitides 54, systemic lupus erythematosus 27, polymyositis/dermatomyositis 25, rheumatoid arthritis 14, IgG4-related disease 13, mixed connected tissue disease 6, Behçet’s disease 5, adult-onset Still’s disease 4, and others 9. The initial dose of glucocorticoids (GC) was 49 mg prednisolone with additional methylprednisolone pulse therapy being conducted in 44 (28.0%). Concomitant immunosuppressive therapies were intravenous cyclophosphamide (IVCY) in 55, calcineurin inhibitor 27, mycophenolate mofetil 16, hydroxychloroquine 5, and methotrexate 4. Concomitant biological agents were rituximab 12, tocilizumab 6, infliximab 2, golimumab 1, and abatacept.
CMV infection occurred in 52 patients (33.1%) and all of them were CMV-IgG positive before induction therapy. Univariable analysis revealed initial prednisolone dose >0.9 mg/kg/day, IV cyclophosphamide, diabetes mellitus and a history of malignancy as independent risk factors for CMV infection.
CMV infection or better reactivation occurs frequently in patients with systemic rheumatic diseases undergoing intensive remission induction therapy. CMV infection occurred only in CMV-IgG positive patients and was related with treatment regimen and comorbidities. In the management of these patients we should think about possible CMV reactivation in the initial phase of intensive induction therapy. The CMV infection may be hazardous for these patients if unrecognized and untreated.