Experience with leflunomide as treatment and as secondary prophylaxis for cytomegalovirus infection in lung transplant recipients: A case series and review of the literature

Silva, José Tiago; Pérez-González, Virginia; López‐Medrano, Francisco; Alonso-Moralejo, Rodrigo; Fernández‐Ruiz, Mario; Juan, Rafael San; Brañas, Patricia; Folgueira, Lola; Aguado, José María; Pablo-Gafas, A. de

doi:10.1111/ctr.13176

Cited by 21 publications

(20 citation statements)

References 21 publications

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“…In one case report and in a retrospective study, LEF (100 mg for 5 days followed by a maintenance dose of 20 mg every 12 h) resulted to be effective in clearing low-dose viremia and long-term CMV suppression in lung transplantation. It must be noted that this small cohort was already taking other anti-viral agents [102]. Three case reports described that LEF could be able to induce a persistent clearance of CMV UL97 and UL54 (genes of resistance against classical anti-viral therapy) in serum and clinical resolution in transplant patients complicated by active CMV retinitis resistant to treatment with systemic and intra-vitreal foscarnet, ganciclovir and oral valganciclovir [103,104].…”

Section: Leflunomidementioning

confidence: 97%

The anti-viral facet of anti-rheumatic drugs: Lessons from COVID-19

Perricone

Triggianese

Bartoloni

et al. 2020

Journal of Autoimmunity

126

131

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Section: Leflunomidementioning

confidence: 97%

The anti-viral facet of anti-rheumatic drugs: Lessons from COVID-19

Perricone

Triggianese

Bartoloni

et al. 2020

Journal of Autoimmunity

126

131

View full text Add to dashboard Cite

“…New advancements in treating ganciclovir-resistant CMV are developing, including leflunomide and T-lymphocyte infusion. Leflunomide, an immunosuppressive therapy for rheumatoid arthritis, has been used as an off-label treatment for drug resistant CMV [122][123][124][125]. Leflunomide inhibits the viral nucleocapsid and tegument development, resulting is decreased cross-resistance from DNA polymerase antivirals.…”

Section: Drug Resistancementioning

confidence: 99%

“…Leflunomide inhibits the viral nucleocapsid and tegument development, resulting is decreased cross-resistance from DNA polymerase antivirals. Successful treatment of CMV disease with leflunomide in solid organ transplant, stem cell transplant and multidrug resistant CMV have been observed [122][123][124][125].…”

Section: Drug Resistancementioning

confidence: 99%

Cytomegalovirus Retinitis in HIV and Non-HIV Individuals

et al. 2019

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Cytomegalovirus retinitis (CMVR) is a severe, vision-threatening disease that primarily affects immunosuppressed patients. CMVR is the most common ocular opportunistic infection in human immunodeficiency virus (HIV) infected patients and is the leading cause of blindness in this group; however, the incidence of CMVR in HIV patients has dramatically decreased with antiretroviral therapy. Other causes of immunosuppression, including organ transplantation, hematologic malignancies, and iatrogenic immunosuppression, can also lead to the development of CMVR. Herein, we describe the pathogenesis of CMVR and compare clinical features, epidemiology, and risk factors in HIV and non-HIV infected individuals with CMVR.

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“…The only case diagnosed with COVID-19 in our cohort has been using le unomide, which is another nbDMARDs that have been demonstrated to have antiviral capacity, particularly against cytomegalovirus and herpes simplex-1 [36,39]. Nevertheless, le unomide is not one of the drugs shining in the strategy against COVID-19 [36].…”

Section: Discussionmentioning

confidence: 92%

The impact of COVID-19 pandemic on pediatric rheumatology patients under immunosuppressive therapy: A single-center experience

Köker

Demirkan

Kayaalp

et al. 2020

Preprint

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Objective: The aim of the research was to further broaden current knowledge of whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) entails a risk for children with rheumatic diseases regarding immunosuppressive treatment.Methods: Telephone-survey was administered by conducting interviews with the parents. A message containing a link to the actual questionnaire was sent to their phones simultaneously. The medical records of the patients were reviewed for gathering information about demographic data, clinical follow-up, and treatments.Results: Patients who were followed up with immunosuppressive treatment (n=439) were attempted to be contacted between 1 May 2020 and 15 May 2020. The diagnostic distribution of patients who were accessible and eligible for the study was as follows; juvenile idiopathic arthritis (JIA) (n=243, 58.7%), autoinflammatory diseases (n=109, 26.3%), autoimmune connective tissue diseases (n=51, 12.3%) and vasculitis (n=11, 2.7%). In the entire cohort, the mean age was 12 ± 4.7 years, and 54.1% (n=224) of the patients were female. One patient with seronegative polyarticular JIA, previously prescribed methotrexate and receiving leflunomide during pandemic has been identified to be diagnosed with COVID-19. None of the patients, including the patient diagnosed with COVID-19, had any severe symptoms. More than half of the patients with household contacts required hospitalization as they were asymptomatic.Conclusion: Although circumstances such as compliance in social distancing policy, transmission patterns, attitude following contact may influence the results, immunosuppressive treatment does not seem to pose additional risk in terms of COVID-19.

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Experience with leflunomide as treatment and as secondary prophylaxis for cytomegalovirus infection in lung transplant recipients: A case series and review of the literature

Abstract: Leflunomide, alone or in combination, could be an effective treatment in selected LT recipients with GCV-resistant CMV infection and as secondary prophylaxis. Further studies are necessary.

Cited by 21 publications

References 21 publications

The anti-viral facet of anti-rheumatic drugs: Lessons from COVID-19

The anti-viral facet of anti-rheumatic drugs: Lessons from COVID-19

Cytomegalovirus Retinitis in HIV and Non-HIV Individuals

The impact of COVID-19 pandemic on pediatric rheumatology patients under immunosuppressive therapy: A single-center experience

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