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Risk factors for serious infections in ANCA-associated vasculitis
Balazs Odler1,2, Regina Riedl3, Philipp Gauckler4
1Department of Medicine, University of Cambridge, Cambridge, UK.
Annals of the Rheumatic Diseases
|January 26, 2023
Summary
Severe infections in antineutrophil cytoplasm antibody-associated vasculitis (AAV) are reduced by trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis. Lower baseline B cell counts may indicate increased infection risk in AAV patients.
Area of Science:
- Immunology
- Rheumatology
- Infectious Disease
Background:
- Severe infections are a major cause of morbidity and mortality in antineutrophil cytoplasm antibody-associated vasculitis (AAV).
- Identifying risk factors for severe infections is crucial for managing AAV patients.
Purpose of the Study:
- To identify risk factors for severe infections in patients participating in the Rituximab versus Cyclophosphamide for ANCA-Associated Vasculitis (RAVE) trial.
- To evaluate the impact of specific treatments and baseline characteristics on infection risk.
Main Methods:
- Analysis of clinical and laboratory data from 197 RAVE trial participants.
- Comparison of patients with and without severe infections (≥grade 3).
- Cox-regression models were used to investigate risk factors for severe infections.
Main Results:
- Most severe infections (82%) occurred within 6 months, primarily respiratory tract infections.
- Lower baseline CD19+ B cell counts were associated with severe infections.
- Higher baseline immunoglobulin M levels increased infection risk, while higher CD19+ B cell counts and *Pneumocystis jirovecii* prophylaxis with trimethoprim-sulfamethoxazole (TMP/SMX) decreased risk.
Conclusions:
- Low-dose TMP/SMX prophylaxis is associated with a reduced risk of severe infections in AAV patients treated with rituximab (RTX) or cyclophosphamide (CYC)/azathioprine (AZA).
- Reduced B cell subpopulations at treatment initiation may correlate with diminished immunocompetence and higher infection risk.
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