Elevation of cytomegalovirus antigenemia predicts serious infection and death in patients receiving immunosuppressive therapies for autoimmune diseases

Abstract

Survival rates of patients with autoimmune diseases have steadily improved. In addition to steroids, several kinds of immunosuppressive reagents have been developed, and the therapeutic protocols are well-designed. Therefore, the disease symptoms of the majority of autoimmune diseases can be controlled, and death due to autoimmune diseases themselves has dramatically waned. However, it remains an unsolved problem how to avoid the occurrence of serious infections, especially opportunistic infections. In cases of systemic lupus erythematosus, the major cause of death during the acute phase is serious infection, not active disease. 1 Moreover, several biologics have been applied to therapeutic strategies for autoimmune diseases, and risks for serious infections are increasing, such as tumor necrosis factor (TNF)-α inhibitors for rheumatoid arthritis (RA). 2 Therefore, it is important to learn how to predict and prevent serious infections in order to achieve better clinical outcomes. Age, functional status, disease activity, comorbidities, previous infections and usage of glucocorticoids and immunosuppressive agents contribute to the risk of infections in RA patients. 3 Also, lymphopenia is a risk factor for increased infection and Pneumocystis jirovecii pneumonia among patients with systemic autoimmune

Baricitinib for anti-melanoma differentiation-associated protein 5 antibody-positive dermatomyositis-associated interstitial lung disease: a case series and literature review on Janus kinase inhibitors for the disease

“…Compared to those reported in the clinical trials for rheumatoid arthritis or other autoimmune diseases, the incidence of CMV reactivation appeared to be high [ 39 ], indicating a more profound immunosuppressive state in anti-MDA5-DM-ILD patients. We have to pay more attention to CMV reactivation in light of the resistant cases as observed in case 3 and our previous observation of a high CMV titer linked to poor outcome in immunosuppressed patients with autoimmune diseases [ 47 ]. In addition to close monitoring of viral load and relating visceral signs, prompt and judicious action of initiating antiviral therapy and/or withholding JAK inhibitors would be required.…”