Risk factors for cytomegalovirus reactivation during the treatment of ANCA-associated vasculitis: A retrospective cohort study of the J-CANVAS study.

OBJECTIVES

Cytomegalovirus (CMV) reactivation during immunosuppressive therapy poses a risk of severe infections. This study aimed to investigate the risk factors of CMV reactivation in patients with microscopic polyangiitis and granulomatosis with polyangiitis using a nationwide cohort in Japan.

METHODS

This retrospective cohort study used data from the Japan Collaborative Registry of antineutrophil cytoplasmic antibody-associated vasculitis. The outcome was as CMV reactivation up to 48 weeks after treatment initiation. We explored the risk factors for CMV reactivation by comparing the two groups.

RESULTS

Of the 454 patients, CMV reactivation occurred in 89 (19.6%). The univariate analysis showed that patients with CMV reactivation were older (P < .001), had higher Birmingham Vasculitis Activity Scores (BVAS) (P = .004) and BVAS renal scores (P < .001), and had received glucocorticoid pulse (P = .004). The logistic regression analysis showed that hypoalbuminemia (odds ratio: 0.55, 95% confidence interval: 0.31-0.98), and low serum IgG (OR: 0.94, 95% CI: 0.89-1.00) were risk factors for CMV reactivation.

CONCLUSIONS

Hypoalbuminemia and low serum IgG levels were risk factors for CMV reactivation. It is necessary to accurately identify high-risk patients and closely monitor their condition.