Daily Steroid Dose Strongly Associated With Cytomegalovirus Antigenemia

For patients with rheumatic diseases, a daily steroid dose is the most important factor associated with the development of cytomegalovirus (CMV) antigenemia, according to study results published in Journal of Infection and Chemotherapy.

Researchers sought to assess the onset of and risk factors associated with CMV antigenemia across several rheumatic diseases.

A retrospective, observational study was conducted at a single institution between 2009 and 2017. Adult patients with rheumatic diseases who underwent at least 1 CMV antigenemia test and had at least 5 years of follow-up were included. Data collected from medical records included patient demographic information, medical history, medication usage, and blood test results. Multivariate and receiver operating characteristic (ROC) analyses were performed to determine factors associated with CMV antigenemia.

Among 249 patients who underwent CMV antigenemia testing, 84 (33.7%) tested positive. Treatment in the CMV antigen-positive group included steroid pulse therapy (n=40) and immunosuppressive medications (n=32). No patients in this group received treatment with biologic medications.

In the multivariate analyses, a prednisolone dosage of at least 45 mg/kg/day was the greatest predictor of CMV (adjusted odds ratio (OR)=16.25; 95% CI, 5.360-49.253). The ROC analysis for steroid dose, lymphocyte count, and IgG level showed the area under the curve was highest for prednisolone dose (0.838; 95% CI, 0.781-0.882). Among patients with newly initiated steroid therapy, the median time to CMV antigen positivity was 30 days. Most of these patients (85.7%) developed CMV antigenemia within 60 days.

Limitations of the study include the potential for patient selection bias due to the study design and variable dosages of therapeutic agents, which were at the discretion of each attending physician.

The study authors conclude, “The findings of this study suggest that the daily dose of steroids is the most important factor associated with CMV antigenemia in patients with rheumatic diseases and that careful CMV monitoring during the first 2 months is highly important after initiating immunosuppressive therapy for the primary disease.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Ogata H, Aoki N, Nagano K, et al. Factors associated with cytomegalovirus antigenemia in patients with rheumatic disease: A retrospective study. J Infect Chemother. Published online August 3, 2022. doi:10.1016/j.jiac.2022.07.004