{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T21:27:52Z","timestamp":1789939672979,"version":"4.0.1"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,12,26]],"date-time":"2017-12-26T00:00:00Z","timestamp":1514246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003329","name":"Ministerio de Econom\u00eda y Competitividad","doi-asserted-by":"publisher","award":["JR14\/00036"],"award-info":[{"award-number":["JR14\/00036"]}],"id":[{"id":"10.13039\/501100003329","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Data concerning the use of leflunomide\u2014a drug approved for rheumatoid arthritis with in vitro anticytomegalovirus (<jats:styled-content style=\"fixed-case\">CMV<\/jats:styled-content>) activity\u2014in lung transplant (<jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content>) recipients are scarce.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To report the use of leflunomide in <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content> recipients diagnosed with <jats:styled-content style=\"fixed-case\">CMV<\/jats:styled-content> infection\/disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>We performed a single\u2010center retrospective study including <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content> recipients who received leflunomide for <jats:styled-content style=\"fixed-case\">CMV<\/jats:styled-content> infection or as secondary prophylaxis after viremia clearance. We also conducted a full systematic PubMed search until June 30, 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 5 <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content> recipients in our center plus 7 patients reported in the literature. All patients had previously received ganciclovir (<jats:styled-content style=\"fixed-case\">GCV<\/jats:styled-content>) and foscarnet (FOS), with drug\u2010induced adverse effects described in 6 recipients (50%). Antiviral resistance mutations were observed in 8 patients (66.7%). Leflunomide was prescribed for <jats:styled-content style=\"fixed-case\">CMV<\/jats:styled-content> infection in 9 of 12 patients (75%) and as secondary prophylaxis in 3 patients (25%). Initial decrease of <jats:styled-content style=\"fixed-case\">CMV<\/jats:styled-content> viremia after starting leflunomide was observed in 7 of 9 recipients (77.7%), although this response was only transient in 2 patients. Long\u2010term suppression of <jats:styled-content style=\"fixed-case\">CMV<\/jats:styled-content> viremia was reported in 7 of 12 patients (58.3%). In 3 recipients (25%), leflunomide was discontinued due to adverse effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Our study has some limitations, such as the small number of patients included, its retrospective nature, and absence of leflunomide drug monitoring in serum. Notwithstanding, in our experience, leflunomide proved to be particularly effective as an anti\u2010<jats:styled-content style=\"fixed-case\">CMV<\/jats:styled-content> secondary prophylaxis treatment and for clearing low\u2010grade viremia. Moreover, leflunomide combined with a short course of <jats:styled-content style=\"fixed-case\">GCV<\/jats:styled-content> or intravitreal <jats:styled-content style=\"fixed-case\">FOS<\/jats:styled-content> also proved to be very effective in some patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Leflunomide, alone or in combination, could be an effective treatment in selected <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content> recipients with <jats:styled-content style=\"fixed-case\">GCV<\/jats:styled-content>\u2010resistant <jats:styled-content style=\"fixed-case\">CMV<\/jats:styled-content> infection and as secondary prophylaxis. Further studies are necessary.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.13176","type":"journal-article","created":{"date-parts":[[2017,12,11]],"date-time":"2017-12-11T08:52:41Z","timestamp":1512982361000},"source":"Crossref","is-referenced-by-count":21,"title":["Experience with leflunomide as treatment and as secondary prophylaxis for cytomegalovirus infection in lung transplant recipients: A case series and review of the literature"],"prefix":"10.1111","volume":"32","author":[{"given":"Jose Tiago","family":"Silva","sequence":"first","affiliation":[{"name":"Unit of Infectious Diseases Hospital Universitario \u201c12 de Octubre\u201d Instituto de Investigaci\u00f3n Hospital \u201c12 de Octubre\u201d (i+12) School of Medicine Universidad Complutense  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"P\u00e9rez\u2010Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Unit of Lung 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