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Related Experiment Videos

Infection hospitalisation in systemic lupus in Sweden.

Julia F Simard1,2, Marios Rossides2, Iva Gunnarsson3

  • 1Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California, USA jsimard@stanford.edu.

Lupus Science & Medicine
|September 16, 2021
PubMed
Summary

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Individuals with Systemic Lupus Erythematosus (SLE) face a significantly higher risk of serious infections compared to the general population. Certain disease-modifying antirheumatic drugs (DMARDs), particularly azathioprine, are linked to increased infection rates in SLE patients.

Area of Science:

  • Rheumatology
  • Infectious Disease Epidemiology
  • Clinical Immunology

Background:

  • Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by immune dysregulation.
  • Treatments for SLE often involve immune-modulating and immunosuppressive therapies, potentially increasing infection risk.
  • Understanding infection risk in SLE patients and the impact of specific treatments is crucial for patient management.

Purpose of the Study:

  • To compare serious infection rates in incident Systemic Lupus Erythematosus (SLE) patients versus the general population.
  • To investigate the role of treatment initiation, specifically disease-modifying antirheumatic drugs (DMARDs) and hydroxychloroquine (HCQ), in SLE-related infection risk.
  • To evaluate the comparative risk of serious infections associated with different DMARDs used in SLE treatment.
Keywords:
antirheumatic agentsepidemiologylupus erythematosussystemictherapeutics

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Main Methods:

  • A Swedish cohort study followed newly diagnosed SLE patients (2006-2013) and general population comparators for serious infections through 2016.
  • Adjusted Cox and frailty models were employed to estimate relative risks for first and recurrent infections.
  • A new-user design compared serious infection rates between DMARD and HCQ initiators, with further analysis of azathioprine, mycophenolate mofetil, and methotrexate.

Main Results:

  • SLE patients had a higher incidence of infections (22% vs. 6%) and more recurrent serious infections (HR=2.22).
  • DMARD initiators showed a higher rate of serious infections compared to HCQ initiators (HR=1.82), though this difference attenuated after adjustment (HR=1.30).
  • Among DMARDs, azathioprine was associated with the highest infection risk (HR=2.19) compared to methotrexate.

Conclusions:

  • Incident SLE patients are 2-4 times more likely to be hospitalized for infection and experience more recurrent infections than the general population.
  • Azathioprine, among DMARD initiators, was associated with the highest rate of serious infections in SLE patients.
  • These findings highlight the importance of monitoring infection risk in SLE patients, particularly those on specific immunosuppressive therapies.