Identifying Risk Factors for Serious Infections in ANCA-Associated Vasculitis

The use of preventive, prophylactic treatment with certain antibiotics may lead to a reduced risk of infections for patients with ANCA-associated vasculitis (AAV) receiving immunosuppressive treatment, according to a recent study published in the Annals of the Rheumatic Diseases.

“The use of low-dose trimethoprim-sulfamethoxazole is associated with reduced risk of severe infections in patients with AAV treated with either rituximab (RTX) or cyclophosphamide (CYC),” the investigators wrote in the report.

The team of researchers analyzed data from 197 patients from the RAVE trial. All patients were randomly given either RTX or CYC, followed by azathioprine (AZA). Majority of the severe infections (82%) were respiratory tract infections and occurred in the first 6 months.

The team found a lower number of CD19+ B cells at baseline, which was more commonly seen in those with relapsing disease —and who thus had received prior immunosuppressive treatment— at the trial’s baseline. Furthermore, antibiotic prophylaxis with TMP/SMX was associated with a lower risk of infection (HR 0.23) independent of the treatment randomization.

Combining trimethoprim-sulfamethoxazole in antibiotic treatment generated good results in preventing severe infections among patients with AAV. “The results suggest that baseline B cell subpopulations might be a potential marker of immunocompetence,” they concluded.

Reference:
Odler B, Riedl R, Gauckler P et al. Risk factors for serious infections in ANCA-associated vasculitis. Annals of the Rheum Dis. 2023;82: 681-687. DOI: http://dx.doi.org/10.1136/ard-2022-223401