Reactivation of latent viruses in individuals receiving rituximab for new onset type 1 diabetes

Jing Lu Kroll, Craig Beam, Shaobing Li, Raphael Viscidi, Bonnie Dighero, Alice Cho, David Boulware, Mark Pescovitz, Adriana Weinberg

Research output: Contribution to journalArticle

Abstract

Background: Rituximab has been successfully used as an experimental therapy in different autoimmune diseases. Recently, a double-blind placebo-controlled phase-2 study in early onset type 1 diabetes showed that rituximab delayed progression of the disease. However, like with any immunosuppressive therapy, there is a concern of opportunistic viral reactivations with the use of rituximab, including herpes and polyomaviruses. Objectives: To study the incidence of new infections and reactivations with BK, JC, Epstein-Barr and cytomegalovirus (BKV, JCV, EBV and CMV) in T1D participants in the phase-2 rituximab study. Study design: Subjects received 4 weekly doses of rituximab (N=57) or placebo (N=30) during the first month of study. Blood samples obtained at weeks 0, 12, 26, 56 and 78 were assayed for CMV, EBV, BKV and JCV by real-time DNA PCR and serology. Results: EBV reactivations were diagnosed by PCR in 25% of placebo, but none of rituximab recipients (p<0.01). There were no episodes of CMV viremia in either treatment group. BKV viremias were significantly more common in the rituximab recipients (9%) compared with placebo controls (0, p<0.01). No JCV reactivations were detected in this study, but among 6 rituximab and 2 placebo recipients who seroconverted for JCV during the study, only one rituximab recipient had detectable viremia. All infections were asymptomatic. Conclusions: Four doses of rituximab administered to individuals with early onset T1D decreased the incidence of asymptomatic EBV reactivations, as predicted by the rituximab-mediated elimination of memory B-cells, but increased the frequency of asymptomatic viremias caused by polyomaviruses.

Original languageEnglish (US)
Pages (from-to)115-119
Number of pages5
JournalJournal of Clinical Virology
Volume57
Issue number2
DOIs
StatePublished - Jun 1 2013

Keywords

  • BK virus
  • Cytomegalovirus
  • Epstein-Barr virus
  • JC virus
  • Rituximab
  • Type 1 diabetes

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

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  • Cite this

    Kroll, J. L., Beam, C., Li, S., Viscidi, R., Dighero, B., Cho, A., Boulware, D., Pescovitz, M., & Weinberg, A. (2013). Reactivation of latent viruses in individuals receiving rituximab for new onset type 1 diabetes. Journal of Clinical Virology, 57(2), 115-119. https://doi.org/10.1016/j.jcv.2013.01.016