Serious infections in systemic lupus erythematosus with a focus on pneumococcal infections

Abstract

Compared to the incidence of invasive pneumococcal infections in the Dutch population (15.6/100.000 patient years), the incidence in SLE patients is 13 times higher. This, in combination with the absence of a relation to use of immunosuppressive drugs, is a strong argument to recommend vaccination against S. pneumoniae in all SLE patients.

Severe infections in patients with lupus nephritis treated with immunosuppressants: A retrospective cohort study

“…Among our LN patients, use of immunosuppressants such as cyclophosphamide and mycophenolate mofetil was associated with severe infections, similar to other studies in SLE patients . Luijten et al and Navarro‐Zarza et al found that glucocorticosteroid and cyclophosphamide use were associated with serious infections requiring hospitalization in univariate analysis but not in multivariate analysis . More recently, a large study of SLE patients diagnosed between 2000 and 2006 found that glucocorticoid use (adjusted HR 1.51, 95% CI (1.06, 1.21), P < 0.05) and immunosuppressants (adjusted HR 1.11 (1.03, 1.20), P < 0.05) were independently associated with hospitalizations for infections .…”

“…This study confirmed that serious infections requiring hospitalization are common among patients with LN and is associated with mortality. The occurrence of serious infections requiring hospitalization in our cohort is much higher than the 15–30% described for most SLE patients . Few longitudinal studies focusing on infective complications in LN patients are available for direct comparison.…”

“…Limitations of this study include its retrospective nature and lack of protocolized therapeutic regimen in treating LN, resulting in difficulty in accurately estimating cumulative drug exposure . Although it may be hard to distinguish infections from SLE flares, consistent findings of similar risk factors in our patients with infections requiring hospitalization and those with bacteraemia or polymicrobial infections makes information or selection bias less likely.…”

Reasons for failure to receive pneumococcal and influenza vaccinations among immunosuppressed patients with systemic lupus erythematosus

“…We found that individuals immunosuppressed with steroids alone (regardless of dosage) were less likely to receive a vaccine recommendation as compared to those receiving DMARDs or biologic medications, which may be due to a perception that the former group are at less risk for infection. While individuals receiving low-dose steroids may be at less risk for infection as compared to those receiving therapy with DMARDs, biologics, or a combination, research shows that steroid therapy, even at low doses, can increase risk of serious infections among lupus patients, and in fact may put patients at greater risk compared to treatment with other DMARD medications (12, 13). Further research is needed to better elucidate the impact of different immunosuppressive drugs and dosages on infection risk, in order to provide evidence to evaluate the practice identified in this study: more frequent recommendation of vaccination for patients immunosuppressed with DMARDs and biologics as compared to those treated with steroids alone.…”

Comorbid infections in patients with systemic lupus erythematosus: State-of-the-art

“…По мнению авторов, данное обстоятельст-во является весомым аргументом в пользу вакцинации против пневмококковой инфекции всех (!) больных СКВ [41].…”