Infliximab Does Not Worsen Outcomes During Flare-ups Associated with Cytomegalovirus Infection in Patients with Ulcerative Colitis.
BACKGROUND
Immunosuppressive therapies used for treating ulcerative colitis are known to favor chronic and latent viral diseases. This study aimed at evaluating prospectively the association between colonic cytomegalovirus (CMV) reactivation and anti-tumor necrosis factor (TNF) monoclonal antibodies (mabs) by comparison to azathioprine (AZA) in a series of flare-ups occurring in consecutive ulcerative colitis patients.


METHODS
A total of 109 flare-ups were recorded in 73 patients receiving a maintenance therapy by anti-TNF mabs (n = 69) or AZA (n = 40). The CMV DNA load in colonic tissue was determined by reverse transcription polymerase chain reaction on a pair of biopsies.


RESULTS
The number of CMV reactivation was of 35% and 38% in patients receiving anti-TNF mabs and AZA, respectively. The median of CMV DNA load was 378 [10-29,800] and 8300 [10-3,25,000] copies/mg of tissue in patients treated by anti-TNF mabs and AZA, respectively (P = 0.11 by Mann-Whitney U test). In a subgroup of 45 patients under anti-TNF mabs requiring an optimized treatment by infliximab, clinical remission (partial Mayo score <3) was not significantly impacted by the presence of CMV reactivation at the time of flare-up (P = 0.52). Twenty of these patients underwent a second colonic biopsy 8 weeks after the initiation of flare-up therapy; except for 3 patients, the colonic CMV DNA load was stable or decreased.


CONCLUSIONS
Patients under anti-TNF maintenance therapy are not at higher risk of CMV reactivation in case of flare-up. No reciprocal adverse influence was observed between anti-TNF mabs and CMV infection, suggesting that these drugs must be considered for treating flare-ups associated to CMV reactivation.
*EA-3064, Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP), Faculty of Medicine of Saint-Etienne, University of Lyon, Lyon, France; †Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, France; ‡Department of Gastroenterology, University Hospital of Saint-Etienne, France; and §Inserm, CIE3, F-42055 Saint-Etienne, France.
Sylvie
S
Pillet
Camille
C
Jarlot
Mathilde
M
Courault
Emilie
E
Del Tedesco
Renaud
R
Chardon
Pierre
P
Saint-Sardos
Emilie
E
Presles
Jean-Marc
JM
Phelip
Philippe
P
Berthelot
Bruno
B
Pozzetto
Xavier
X
Roblin
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003106:Colon / Q000473:pathology / Q000821:virology; D003113:Colonoscopy; D003587:Cytomegalovirus / Q000235:genetics*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014775:Virus Activation
D000998:Antiviral Agents; D004279:DNA, Viral; D005765:Gastrointestinal Agents; D000069285:Infliximab