Risk of cytomegalovirus reactivation in patients with immune-mediated inflammatory diseases undergoing biologic treatment: a real matter?

Abstract

The use of biological agents has grown exponentially in immune-mediated inflammatory diseases (IMID), often achieving a good control of disease progression and improving patients’ quality of life. However, their use resulted in an increased risk of adverse events, including reactivation of chronic/latent infectious diseases. As for the risk of Cytomegalovirus (CMV) reactivation, very few data are available. We reviewed the literature reporting cases of CMV infection in IMID patients during biological therapy. Although the risk of CMV reactivation cannot be excluded, we concluded that there is no evidence to warrant CMV screening before starting a biological agent.

<p>CMV Infection: A Clinical Challenge in Biological Therapy? The Case of Asymptomatic Patients with Persistent Positive Immunoglobulin M Anti-CMV Treated with Secukinumab</p>

“…3 In a brief review of the literature, Mencarini et al identified 14 cases of CMV infections during biological therapy with anti-TNF-α in IMID patients. 4 It was not clearly described whether the infections were primary or reactivations. Nevertheless, temporary discontinuation of the biological drug led to the improvement of the patients' condition in almost all cases.…”

“…Nevertheless, temporary discontinuation of the biological drug led to the improvement of the patients' condition in almost all cases. 4 However, there is a lack of guidelines in the case of asymptomatic patients who have had a CMV infection with positive IgM anti-CMV and IgG anti-CMV and who need to undergo therapy with biological agents. Indeed, the presence of IgM anti-CMV in the bloodstream is not always characteristic of the acute/recent phase of the infection.…”