Pos0534 predictors of Serious Infections in Rheumatoid Arthritis – A Prospective Brazilian Cohort

Abstract

BackgroundInfectious intercurrences increase mortality and morbidity and often limit immunosuppressive treatment in rheumatoid arthritis (RA) patients [1].The risk of infection in this population may be influenced by factors related to treatment, the characteristics of rheumatic disease and the clinical and social conditions of patients [2].ObjectivesThis study aims to evaluate the incidence and factors related to the occurrence of serious infections, defined as the need for hospitalization or the use of intravenous antibiotics for the treatment, among patients with rheumatoid arthritis in Brazil.MethodsWe analyzed data from the REAL [3], a prospective observational study, that evaluated Brazilian RA patients, with clinical and laboratory data collected over a year in eleven tertiary health care centers. Were included patients with 18 years or older, who fulfilled classification criteria for RA and were previously followed up in rheumatology services for at least 6 months prior to inclusion. Exclusion criteria was the absence of information regarding the occurrence of infections in two or more visits. Univariate and multivariate analyses were performed from the adjustment of the logistic regression modelGeneralized Estimating Equations(GEE), with the primary outcome being the occurrence of serious infection. We assessed the corticosteroid dose that was most associated with the occurrence of serious infections, maximizing sum of sensitivity and specificity.Results841 patients were included with an average follow-up time of 11,2 months (SD 2,4). Eighty-nine serious infections occurred, corresponding to 13 infections per 100 patient-years. The association between corticosteroid use and severe infections was dose-dependent until daily doses equal to or higher than 15 mg of prednisone (or equivalent) in which the highest association was found. Pulmonary fibrosis, chronic kidney disease (CKD) and central nervous system disease increased the chances of serious infection by 3.2 times (95% CI: 1.5 to 6.9), 3.6 times (95% CI: 1.2 to 10.4) and 2.4 times (95% CI: 1.2 to 5.0), respectively. The use of corticosteroids in moderate doses increased the chances by 5.4 times (95% CI: 2.3 to 12.4), and for each increase of 1 unit in the health assessment questionnaire (HAQ), the chance increased 60% (95% CI: 20 to 120%).Table 1.Multivariable analysisCoef.Value-pOR95% CITime (Visit)0,81<0,0012,2(1,8-2,8) Pulmonary fibrosis1,170,0033,2(1,5-6,9)Chronic kidney disease1,270,023,6(1,2-10,4)CNS Diseases0,890,0152,4(1,2-5,0)Prednisone (or equivalent) dose (≥ 15 mg)1,68<0,0015,4(2,3-12,4)HAQ0,460,0051,6(1,2-2,2)Legend: Coef - coefficients. OR - Odds Ratio. 95%CI - 95% confidence interval. CNS - Central nervoussystem diseases. HAQ - health assessment questionnaireConclusionWe observed a high incidence rate of serious infections in this Brazilian cohort compared with cohorts from developed countries. The factors that were independently associated with them were neurological and pulmonary comorbidities, reduced kidney function, use of corticosteroids in moderate doses and reduced functionality. These findings may affect therapeutic decisions in RA patients.References[1]SUBESINGHE, S. et al. Biologic prescribing decisions following serious infection: results from the British Society for Rheumatology Biologics Register-Rheumatoid Arthritis.Rheumatology (Oxford),v. 57, n. 12, p. 2096-2100, 12 01 2018. ISSN 1462-0332. Disponível em: <https://www.ncbi.nlm.nih.gov/pubmed/29986108>.[2]DORAN, M. F. et al. Predictors of infection in rheumatoid arthritis.Arthritis Rheum,v. 46, n. 9, p. 2294-300, Sep 2002. ISSN 0004-3591. Disponível em: <https://www.ncbi.nlm.nih.gov/pubmed/12355476>.[3]DA ROCHA CASTELAR-PINHEIRO, G. et al. The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil.Adv Rheumatol,v. 58, n. 1, p. 9, Jun 28 2018. ISSN 2523-3106. Disponível em: <https://www.ncbi.nlm.nih.gov/pubmed/30657089>.Acknowledgements:NIL.Disclosure of InterestsAna Luisa Bagno de Almeida: None declared, Maria Fernanda Guimarães Speakers bureau: AbbVie, Bristol-Myers-Squibb, Janssen, Novartis, Pfizer, Roche and UCB., Grant/research support from: AbbVie, Bristol-Myers-Squibb, Janssen, Novartis, Pfizer, Roche and UCB., Maria RAQUEL DA COSTA PINTO: None declared, Leticia Pereira: None declared, Ana Paula Gomides: None declared, Karina Bonfiglioli Grant/research support from: Abbvie, Boheringer Ingelheim, Bristol-Myers-Squibb, Janssen, Novartis and Roche., Paulo Louzada Jr: None declared, Rina Giorgi Grant/research support from: AbbVie, Bristol-Myers-Squibb, Eli Lilly, Janssen and UCB., Glaucio Castro: None declared, Sebastiao Radominski Speakers bureau: AbbVie, Amgen, Bristol-Myers-Squibb, Lilly, Pfizer, and Roche, Consultant of: AbbVie, Amgen, Bristol-Myers-Squibb, Lilly, Pfizer, and Roche, Grant/research support from: AbbVie, Amgen, Bristol-Myers-Squibb, Lilly, Pfizer, and Roche, Claiton Brenol Speakers bureau: AbbVie, Bristol-Myers-Squibb, Janssen, Novartis, Pfizer, Roche and UCB., Grant/research support from: AbbVie, Bristol-Myers-Squibb, Janssen, Novartis, Pfizer, Roche and UCB., Alisson Pugliesi: None declared, Licia Mota Speakers bureau: AbbVie, Boehringer Ingelheim, GSK, Janssen, Libbs, Lilly, Novartis, Pfizer, Roche, Sandoz, and UCB., Grant/research support from: AbbVie, Janssen, Pfizer and Roche, Geraldo da Rocha Castelar Pinheiro: None declared.