Meta-analysis confirms elevated infection risk in SLE
medwireNews: Patients with systemic lupus erythematosus (SLE) are at greater risk for infections than the general population, shows a meta-analysis.
The risk was two- to sixfold higher for “overall severe infection, tuberculosis, pneumonia and herpes zoster compared with the general population or healthy controls,” say the researchers.
As reported in Rheumatology, the meta-analysis included a total of 11 retrospective or prospective cohort studies that analyzed the risk for severe infection (n=4), tuberculosis (n=3), pneumonia (n=6), and herpes zoster (n=2) in adults with SLE relative to the general population or a healthy control population.
In a pooled analysis, the risk for severe infection was a significant 2.96 times greater for the SLE than the control group, while the risk ratios for tuberculosis, pneumonia, and herpes zoster infections were 6.11, 2.58, and 2.50, respectively.
“Demographics and SLE-related factors, including age, sex, the disease itself and treatment, are likely to be important in explaining this elevated risk,” say Edward Hammond (AstraZeneca, Gaithersburg, Maryland, USA) and colleagues.
Indeed, younger age was associated with an increased infection risk; in one study patients aged 18–24 years were nearly nine times more likely than their age-matched healthy controls to have herpes zoster, while the risk was just over double for people older than 65 years versus age-matched controls.
And in another study, the risk for severe infection was nearly fourfold higher for patients initiating glucocorticoids without antimalarials than for those starting antimalarials without glucocorticoids.
But the authors did not find any associations between sex or length of SLE diagnosis and risk for infections.
“Multiple sensitivity analyses confirmed the robustness of the results even in the presence of heterogeneity,” note Hammond et al.
They stress the need for “[e]fforts to strengthen strategies aimed at preventing infections in SLE,” and propose “different strategies such as general hygienic measures, vaccinations, detection of latent infections and antibiotic prophylaxis.”
The team continues: “Such approaches may include pneumococcal and influenza vaccinations in patients with stable disease, screening for specific chronic viral infections or for tuberculosis before glucocorticoids and immunosuppressive treatment, or the use of appropriate prophylaxes (e.g. oral trimethoprim-sulfamethoxazole for prophylaxis of Pneumocystis jiroveci pneumonia) or drug modifications when indicated.”
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