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Int J Rheum Dis. 2019 Apr;22(4):583-591. doi: 10.1111/1756-185X.13467. Epub 2019 Feb 10.

Pulse corticosteroids in treatment of rheumatic disease concomitant with cytomegalovirus infection.

Author information

1
Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Peking-Tsinghua Center for Life Sciences, Beijing, China.
2
Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China.

Abstract

AIM:

To investigate the impact of corticosteroids on the outcome of antiviral therapy in rheumatic patients with cytomegalovirus (CMV)-emia.

METHOD:

Sixty-two patients with rheumatic disease complicated by CMV infection from 2011 to 2014 were retrospectively analyzed.

RESULTS:

Fifty-five of 62 patients were diagnosed with CMV-DNAemia. Most patients (43/55, 78.2%) achieved viral clearance within 5 weeks. It was shown that, while undergoing active antiviral therapy, there was no significant difference in the CMV-DNAemia clearance rate between the pulse methylprednisolone (MPSL) therapy group and non-pulse group (8/9, 88.9% vs 30/36, 83.3%; OR = 1.600, 95% CI 0.168-15.273, P > 0.05) at the end of the 5-week follow-up. However, pulse MPSL might slightly prolong duration of CMV-DNAemia than non-pulse MPSL patients (20.78 ± 19.18 days vs 14.33 ± 9.01 days, P = 0.1430), especially in the high baseline titer group (33.7 ± 29.1 days in pulse MPSL group vs 18.3 ± 13.1 days in non-pulse group, P = 0.457). But in the low baseline titer group, CMVemia duration in the pulse MPSL group (14.3 ± 10.0 days) was about the same as that in the non-pulse MPSL group (13.4 ± 7.8 days).

CONCLUSION:

With effective antiviral therapy, pulse MPSL is acceptable in rheumatic disease patients with CMV-DNAemia, without significant impact on final clearance of virus. However, duration of CMV-DNAemia may be prolonged, especially in patients with high CMV-DNA titer at baseline.

KEYWORDS:

corticosteroids; cytomegalovirus; rheumatic disease; viral clearance

PMID:
30740904
DOI:
10.1111/1756-185X.13467

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