Risk Factors for Cytomegalovirus Reactivation during the Treatment of ANCA-Associated Vasculitis: A retrospective cohort study of the J-CANVAS study

Abstract 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 anti-neutrophil 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<0.001), had higher Birmingham Vasculitis Activity Scores (BVAS) (p=0.004) and BVAS renal scores (p<0.001), and had received glucocorticoid pulse (p=0.004). The logistic regression analysis showed that hypoalbuminemia (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 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.