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Increased frequency of JC-polyomavirus detection in rheumatoid arthritis patients treated with multiple biologics

Jens Verheyen1, Kseniya Maizus, Eugen Feist

  • 1Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Cologne, Germany, jens.verheyen@uk-essen.de.

Medical Microbiology and Immunology
|February 14, 2015
PubMed

Insights

JC-polyomavirus (JCPyV) reactivation is a risk in rheumatoid arthritis (RA) patients treated with biologics. Higher JCPyV DNA prevalence in urine correlates with multiple biologic treatments, suggesting JCPyV antibody screening for PML risk stratification.

Area of Science:

  • Immunology
  • Virology
  • Rheumatology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, fatal JC-polyomavirus (JCPyV) reactivation.
  • PML has been observed in autoimmune disease patients, including rheumatoid arthritis (RA), treated with rituximab.
  • Biologic agents are increasingly used for RA, necessitating an understanding of associated viral risks.

Purpose of the Study:

  • To investigate the prevalence and patterns of JCPyV infection in RA patients undergoing biologic therapy.
  • To determine if the number or type of biologic agents influences JCPyV detection.
  • To assess the potential of JCPyV antibody screening for PML risk stratification in RA patients.

Main Methods:

  • Analysis of urine and blood samples from 80 RA patients for JCPyV DNA and antibody levels.
  • Genotyping of JCPyV control region and VP1 in positive specimens.
  • Correlation analysis between JCPyV detection, antibody titers, and patient treatment history (number of biologic agents).

Main Results:

  • JCPyV DNA was detected in the urine of 33% of RA patients.
  • Viremia was transient and detected in only two patients, without PML-associated mutations.
  • Significantly higher JCPyV DNA prevalence and antibody titers were observed in patients treated with two or more biologic agents compared to those on their first biologic.
  • JCPyV DNA detection in urine strongly correlated with JCPyV antibody positivity.

Conclusions:

  • The number of biologic agents used in RA treatment impacts JCPyV detection patterns.
  • JCPyV infection prevalence and antibody response increase with cumulative exposure to biologic therapies.
  • JCPyV antibody screening may be a valuable tool for PML risk stratification in RA patients undergoing biologic treatment.

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