Infliximab and the risk of latent viruses reactivation in active Crohnʼs disease

Abstract

Our results support the safety of short-term infliximab treatment with respect to latent virus reactivation. The long-term effects of infliximab, particularly for the issue of lymphoproliferative disorders, warrants further studies with larger populations, but so far data are reassuring.

Viral infection and reactivation in autoimmune disease

“…Crohn's disease, infliximab therapy did not appear to be associated with JCV activation (72). In addition, a trial in 146 patients with relapsing-remitting MS demonstrated that treatment with IFN beta as monotherapy did not appear to have any effect on active replication of JCV (73), whereas another study in a similar patient group showed that treatment with IFN beta could lead to a reduction in JCV DNA levels in the peripheral blood (74).…”

Risk of Infections of Biological Therapies with Accent on Inflammatory Bowel Disease

“…CMV serology was positive in 70.0% of samples collected before IFX infusions in consecutive CD patients, indicating latent viral presence. CMV replication and reactivation was not observed (201). CMV was not detected in a pediatric IBD sample treated with biologicals or conventional therapies for over 12 months (202).…”

“…No patient became positive for HHV-6, HHV-7 and HHV-8 in blood samples at any point in a sample of 60 consecutive CD patients treated with IFX (201). HHV-6 was not detected in urine, serum or peripheral blood mononucleated cells in a pediatric IBD cohort treated with biologicals or conventional therapies for over 12 months (202).…”

“…EBV positivity is an important infectious adverse event as it can lead to both malignant and non-malignant complications (223). EBV serology was positive in 98.3% of serological samples collected before IFX infusions in consecutive CD patients, showing latent viral presence (201). However, EBV replication and reactivation was only observed in 11.7% of patients at week 0, 3.3% at week 2, and 3.3% at week 14, with low viremia (50-600 copies/mL), indicating transient replication.…”

“…However, EBV replication and reactivation was only observed in 11.7% of patients at week 0, 3.3% at week 2, and 3.3% at week 14, with low viremia (50-600 copies/mL), indicating transient replication. Concomitant methotrexate was associated with EBV viremia by polymerase chain reaction (PCR) (OR 7.5, 95% CI 1.4-40.1, p=0.025) (201).…”