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DMARD-Treated Patients With SLE at Heightened Risk of Infection
Patients with systemic lupus erythematosus (SLE) who were treated with disease-modifying antirheumatic drugs (DMARDs) were at significantly higher risk of hospitalization for serious infections and experienced recurrent infections more often than the general population, according to research from Sweden.
Investigators compared patients from the Swedish Lupus Linkage cohort who were newly diagnosed with SLE between 2006 and 2013 with healthy controls. These patients were followed for serious infection through 2016; the rates of serious infections were compared among patients who initiated therapy with DMARDs and hydroxychloroquine (HCQ). The researchers used multivariable-adjusted models to evaluate the rates of infection among patients treated with azathioprine, mycophenolate mofetil, or methotrexate.
Using adjusted Cox and frailty models, the study team calculated the relative risk of first and recurrent infections between the cohorts and found that patients with SLE evidenced more infections, especially during the first year after diagnosis and treatment initiation, than the comparison cohort (22% vs 6%). These patients were also at higher risk of recurrent infections, the researchers found.
“DMARDs were associated with a higher rate of serious infection versus HCQ (HR=1.82, 95% CI 1.27 to 2.60), which attenuated after multivariable-adjustment (HR=1.30, 95% CI 0.86 to 1.95),” the authors stated. “Among DMARDs, azathioprine was associated with infection (HR=2.19, 95% CI 1.14 to 4.21) and mycophenolate mofetil yielded an HR=1.39 (95% CI 0.65 to 2.96) in multivariable-adjusted models compared with methotrexate. Results were comparable across numerous sensitivity analyses.”
--Rebecca Mashaw
Reference:
Simard JF, Rossides M, Gunnarsson I, Svenungsson E, Arkema EV. Infection hospitalisation in systemic lupus in Sweden. Lupus Sci Med. 2021;8(1):e000510.
