Antimalarial treatment and minimizing prednisolone are associated with lower risk of infection in SLE: a 24-month prospective cohort study

Prata, Ana Rita; Luís, Mariana; Assunção, H.; Silva, José António Pereira da; Inês, Luís

doi:10.1007/s10067-021-05988-x

Cited by 8 publications

(8 citation statements)

References 44 publications

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“…The result was in contrast with the prior studies of the adult-onset SLE patients that the risk of the infection could be increased by the glucocorticoid with the dose effect. 16 , 17 This discrepancy may be explained by the Wu et al’s finding 18 that the phagocytic ability of polymorphonuclear cells (PMNs) was not influenced by the cumulative steroid dose or the immunosuppressive medication in the cSLE patients, even the phagocytic ability was impaired compared with the normal controls. It seems that the immune disturbance of the SLE itself rather than the glucocorticoid is the essence of the reason why the newly diagnosed cSLE is prone to have higher risks of major infections.…”

Section: Discussionmentioning

confidence: 99%

Major Infections of Newly Diagnosed Childhood-Onset Systemic Lupus Erythematosus

Bao¹,

Lu²,

Huang³

et al. 2023

JMDH

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Objective To evaluate the risk of major infections in children with newly diagnosed childhood-onset systemic lupus erythematosus (cSLE). Methods Predictors of major infections were identified by the multivariable logistic regression. Major infection free was defined as no major infection events within 6 months after the diagnosis of cSLE. The Kaplan–Meier survival plot was performed. A prediction model for major infection events was established and examined by receiver operating characteristic (ROC) curve analysis. Results A total of 98 eligible patients were recorded in the medical charts. Sixty-three documented events of major infections were found in 60 (61.2%) cSLE patients. Furthermore, 90.5% (57/63) of infection events occurred within the first 6 months after the diagnosis of cSLE. The high SLEDAI (SLEDAI >10), lupus nephritis and lymphocyte count <0.8×109/L were predictors for major infections. The CALL score (Children with high disease activity [SLEDAI >10], lymphopenia, and LN) was defined by the number of predictors. Patients were then categorized into two groups: low-risk (score 0–1) and high-risk (score 2–3). Patients in the high-risk group had higher rates of the major infection occurrence than those in the low-risk group during the 6 months after the diagnosis of the cSLE (P<0.001) (HR:14.10, 95% CI 8.43 to 23.59). The ROC curve analysis indicated that the CALL score was effective both in the whole cSLE cohort [area under the curve (AUC) = 0.89, 95% CI: 0.81–0.97] and in the subgroup of lung infections (n = 35) (AUC = 0.79, 95% CI: 0.57–0.99). Conclusion High disease activity, LN and lymphopenia were predictors for major infections in newly diagnosed cSLE patients. Specific predictors help identify the cSLE patients with the high risk of major infections. The CALL score could be a useful tool to stratify cSLE patients in practice.

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Section: Discussionmentioning

confidence: 99%

Major Infections of Newly Diagnosed Childhood-Onset Systemic Lupus Erythematosus

Bao¹,

Lu²,

Huang³

et al. 2023

JMDH

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“…Other factors associated with serious infection across studies include serositis, renal involvement, anemia, thrombocytopenia, hypoproteinemia, hypoalbuminemia, low C3, and the presence of diabetes (Table 5 ) [ 5 , 10 , 15 , 16 , 20 , 25 , 43 ]. Increasing daily corticosteroid dose and immunosuppressants such as cyclophosphamide, mycophenolate mofetil, and rituximab were also predictors of infection whereas cumulative use of hydroxychloroquine was protective [ 15 , 44 , 45 ]. Our models found a 65% increase in serious infections for every 10-mg increase in corticosteroid dose whereas adjusted for the steroid dose, the use of cyclophosphamide no longer conferred any additional risk.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis remains a leading contributor to morbidity due to serious infections in Indian patients of SLE

et al. 2023

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Introduction Infections are a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). We assessed the incidence and risk factors for major infections in SLE in India. Methods A retrospective review of a cohort of 1354 patients of adult SLE (ACR 1997 criteria) seen between 2000 and 2021 at a single center was conducted. Serious infections (need for hospitalisation, prolonged intravenous antibiotics, disability, or death) were recorded. Cox regression was used to determine factors associated with serious infection and the effects of serious infection on survival and damage. Results Among the 1354 patients (1258 females, mean age of 30.3 years, follow-up of 7127.89 person-years), there were 439 serious infections in 339 patients (61.6 per 1000 person-years follow-up). Bacterial infections ( N = 226) were the most common infection followed by mycobacterial infections ( n = 81), viral ( n = 35), and then invasive fungal infections ( N = 13). Mycobacterium tuberculosis was the single most common microbiologically confirmed organism with incidence of 1136.4/100,000 person-years with 72.8% of them being extrapulmonary. Infection free survival at 1 year and 5 years was 82.9% and 73.8%. There were 119 deaths with infection attributable mortality in 65 (54.6%). On multivariable Cox regression analysis, higher baseline activity (HR 1.02, 1.01–1.05), gastrointestinal involvement (HR 2.75, 1.65–4.69), current steroid dose (HR 1.65, 1.55–1.76), and average cumulative steroid dose per year (HR 1.007, 1.005–1.009) were associated with serious infection and higher albumin (HR 0.65, 0.56–0.76) was protective. Serious infections led to greater damage accrual (median SLICC damage index of 1 vs. 0) and mortality (HR was 18.2, 32.7 and 81.6 for the first, second, and third infections). Conclusion Serious infections remain a major cause of mortality and damage accrual in SLE and higher disease activity, gastrointestinal involvement, hypoalbuminemia, current steroid dose, and cumulative steroid dose are the risk factors for it. Key Points • Tuberculosis is still a major cause of morbidity in South Asian patients of SLE. • Serious infections are associated with higher damage accrual and mortality in patients with SLE. • Higher disease activity, gastrointestinal involvement, hypoalbuminemia, and current steroid dose were associated with increased risk of infection. • This study provides data to enable specific recommendations for infection prevention in SLE for the South Asian region. Supplementary information The online version contains supplementary material available at 10.1007/s10067-023-06592-x.

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“…En contrapartida a otros autores 22,41,[47][48][49] , en el presente trabajo no se encontró diferencia con el uso de antimaláricos, ni pudo demostrarse su efecto beneficioso porque su empleo en este grupo de pacientes representó más del 90%.…”

Section: Discussionunclassified

Lupus en Argentina. Pacientes no respondedores al tratamiento estándar y belimumab como posible opción. Datos del registro RELESSAR

Quintana

García

Gobbi

et al. 2022

Rev. Argent. Reumatol.

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Introducción: el lupus es una enfermedad compleja y varias veces de difícil abordaje. Alcanzar la remisión es uno de los objetivos, incorporando opciones terapéuticas. Objetivos: describir las características generales de los pacientes según el estado de la enfermedad y el uso de belimumab. Materiales y métodos: estudio de corte transversal, registro RELESSAR. Se definió el estado de la enfermedad como: remisión: SLEDAI=0 y sin corticoides; baja actividad de la enfermedad: SLEDAI >0 y ≤4 y sin corticoides; control no óptimo: SLEDAI >4 y cualquier dosis de corticoides. Resultados: se incluyeron 1.277 pacientes, 23,4% en remisión, 12,6% en baja actividad y 63,8% con control no óptimo. En este último grupo eran más jóvenes y con menor duración de la enfermedad; presentaban mayores índices de actividad y cronicidad, y mayor empleo de inmunosupresores. Solo el 22,3% de los pacientes con criterio potencial de uso de belimumab (lupus eritematoso sistémico activo a pesar del tratamiento estándar) lo recibía en ese momento. Las variables asociadas a hospitalizaciones fueron: terapia con corticoides, ciclofosfamida y mayor SLICC. Conclusiones: se refleja la complejidad del manejo de estos pacientes y se visualizan aspectos estructurales como la desigualdad. El uso del belimumab resultaría beneficioso en los pacientes seleccionados.

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Antimalarial treatment and minimizing prednisolone are associated with lower risk of infection in SLE: a 24-month prospective cohort study

Cited by 8 publications

References 44 publications

Major Infections of Newly Diagnosed Childhood-Onset Systemic Lupus Erythematosus

Major Infections of Newly Diagnosed Childhood-Onset Systemic Lupus Erythematosus

Tuberculosis remains a leading contributor to morbidity due to serious infections in Indian patients of SLE

Lupus en Argentina. Pacientes no respondedores al tratamiento estándar y belimumab como posible opción. Datos del registro RELESSAR

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