P542 Per oral antiviral treatment with valganciclovir for patients with cytomegalovirus-positive ulcerative colitis in the outpatient setting: report of 5 cases
H. Tamaki*, T. Noda, S. Arasawa, M. Izuta, A. Kubo, C. Ogawa, T. Matsunaka, M. Shibatoge
Takamatsu Red Cross Hospital, Gastroenterology, Takamatsu, Japan
Cytomegalovirus (CMV) reactivation is considered to be an important exacerbating factor for flare ups in patients with ulcerative colitis (UC). Intravenous ganciclovir (GCV) is the standard antiviral treatment for CMV, although the timing and necessity of such treatment remain unclear. In contrast, oral valganciclovir (VGC)—a prodrug of GCV—has comparable efficacy to GCV in viremia eradication and is associated with fewer complications; however, there are only a few reports of VGC treatment for patients with CMV-positive UC.
Five patients who were diagnosed with CMV-positive UC by mucosal polymerase chain reaction analysis were treated with oral VGC at the therapeutic dose (900 mg twice daily for 21 days) in the outpatient setting. The patients’ symptoms, physical findings, and blood test results were assessed on days 7 and 21 during the treatment period and 4 weeks after the treatment. The endoscopic examination was performed during month 2 to 3 after the treatment.
We enrolled 5 patients (3 men and 2 women; mean age, 66 years [range, 60–67 years]) with moderate-to-severe UC (Lichtiger clinical activity index [CAI], 6–10). The Mayo endoscopic score was 3 in 1 patient, 2 in 3 patients and 1 in 1 patient. The concomitant treatment was mesalamine, prednisolone, and infliximab in 2 patients; prednisolone and infliximab in 1 patient; mesalamine and rectal administration of steroids in 1 patient; and mesalamine and infliximab in 1 patient at the beginning of antiviral treatment. We observed a decrease in the CMV-DNA copy number detected by mucosal PCR after the treatment (15 ± 0.93 × 10E3 at baseline to 0.84 ± 0.08 × 10E3 at 2 to 3 month after the treatment, p = 0.14). Although 4 patients (80%) reached normal level of CMV-DNA copy number after treatment with VGC, it increased in 1 patient (20%). Further, 4 patients (80%) achieved clinical remission (CAI ≤ 3) within 4 weeks after treatment. One patient (20%) experienced relapse 22 weeks later. Dizziness and rash were observed in 1 patient, whereas general malaise was reported in 2 patients. One of the patients aborted the treatment on day 19 because of nausea.
Antiviral treatment with oral VGC for outpatients with CMV-positive UC was relatively safe and tolerable. It may potentially serve as an alternative to intravenous GCV therapy.