ArticleAdvances in rheumatology (London, England)2026
Cytomegalovirus infection in patients with rheumatic disorders under rituximab treatment: a scoping review.
Article in Advances in rheumatology (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCytomegalovirus (CMV), a DNA virus known for asymptomatic infections in immunocompetent individuals, can lead to fatal complications in the setting of immunosuppression. Rituximab (RTX) is an anti-CD20 monoclonal antibody with immunosuppressive properties, used as a first-line treatment choice for various rheumatic disorders. Although multiple reviews have analyzed the effects of RTX on CMV infection incidence in the population with a history of transplantation and malignancies, limited data are available on CMV incidence in those with rheumatic disorders under RTX treatment.
methodsIn August 2025, a thorough search in PubMed, EMBASE, Web of Science, MEDLINE (Ovid), and Scopus was conducted according to the framework proposed by Arksey and O’Malley, and the PRISMA-ScR guidelines were employed for reporting and structuring the research question (Population: individuals with rheumatic disorders, Concept: association between RTX administration and CMV infection, Context: RTX exposure) Tricco (Ann Intern Med 169(7):467-73, 2018). Original English studies on human subjects with rheumatic disorders infected with CMV infection or disease were included. The RTX dosage range was defined as low (doses < 500 mg per infusion), moderate (doses ranging from 500 to 1000 mg per infusion), and high (doses ≥ 1000 mg per infusion). Following abstract and full-text screening, relevant data were compiled into an Excel spreadsheet.
resultsA total of 13 studies, involving 459 patients, were recorded, among which 23 (5.01%) CMV infectious episodes were identified, most commonly reported as reactivation (39.13%, n = 9). The majority of CMV episodes occurred in individuals with anti-neutrophil cytoplasmic antibody-associated vasculitis and dermatomyositis, accounting for six cases. Six (2.57%), 10 (83.33%), and one (1.31%) infectious episode were reported among those with a history of low-, moderate-, and high-dose infusions, respectively. One fatal episode of CMV pneumonia occurred in a female patient diagnosed with MPA who was previously treated with four low-dose infusions of RTX.
conclusionThis review’s findings illustrated a 5% prevalence of CMV infection following RTX infusion in patients with rheumatic disorders. Accurately estimating the infection burden of this population requires more extensive and precise studies.
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