Infliximab and the risk of latent viruses reactivation in active Crohn's disease.

Abstract

BACKGROUND:

Infliximab is used for refractory Crohn's disease but there are concerns regarding long-term safety. Recently, JC-polyomavirus (JCV) was studied after 3 cases of progressive multifocal leukoencephalopathy (PML) were found after treatment with natalizumab. The aim of this study was to investigate the short-term effect of infliximab on reactivation of several harmful latent viruses.

METHODS:

Sixty consecutive patients scheduled for infliximab induction course were prospectively enrolled. Blood samples were taken before each infliximab infusion at 0, 2, 6, and 14 weeks. Specific polymerase chain reaction (PCR) analyses were performed to detect JCV, Epstein-Barr virus (EBV), human herpes virus-6, (HHV-6), -7, -8, and cytomegalovirus (CMV).

RESULTS:

Indications to infliximab were luminal and fistulizing disease in 49 and 15 cases, respectively. Clinical improvement and remission were achieved in 54 (90%) and 39 (65%) of patients, respectively, at 6 weeks. No patient was JCV-positive at any timepoint. EBV serology was positive for 59/60 patients (98%); EBV-PCR tests were transiently positive (>40 copies/10(5) Peripheral blood mononuclear cells, PBMC) in 4 (7%) patients after infliximab, but in each case were negative at subsequent timepoints. All patients were negative for HHV-6, -7, and -8 at all timepoints. CMV serology was positive in 42 patients (70%), but no CMV-PCR-positive patient was observed. There was no association between concomitant treatments or clinical characteristics and viral status.

CONCLUSIONS:

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.

• Authors: Alessandro Lavagna, Massimiliano Bergallo, Marco Daperno, Raffaello Sostegni, Cristina Costa, Rosalia Leto, Lucia Crocellà, Giancarlo Molinaro, Rodolfo Rocca, Rossana Cavallo, Angelo Pera
• Journal: Inflammatory bowel diseases (Inflamm Bowel Dis) Vol. 13 Issue 7 Pg. 896-902 (Jul 2007) ISSN: 1078-0998 [Print] England
• PMID: 17345605 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Viral
• DNA, Viral
• Gastrointestinal Agents
• Infliximab

Topics

• Adult
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Antibodies, Viral (blood)
• Betaherpesvirinae (isolation & purification)
• Crohn Disease (drug therapy, virology)
• DNA, Viral (blood)
• Gastrointestinal Agents (adverse effects, therapeutic use)
• Herpesvirus 4, Human (isolation & purification)
• Herpesvirus 8, Human (isolation & purification)
• Humans
• Infliximab
• JC Virus (isolation & purification)
• Middle Aged
• Polymerase Chain Reaction
• Prospective Studies
• Virus Activation (drug effects)
• Virus Latency (drug effects)