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Antimalarial treatment and minimizing prednisolone are associated with lower risk of infection in SLE: a 24-month prospective cohort study

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Abstract

Introduction/objectives

Infections are a major cause of morbidity and death in systemic lupus erythematosus (SLE). Perfecting the understanding of contributors to infection burden in SLE is pivotal to improve management and outcomes. This study aims to identify clinical predictors of infection in SLE.

Method

We conducted a prospective cohort study at a referral SLE clinic. Infections were identified at each visit and categorized as (a) any type, (b) serious, (c) non-serious, and (d) bacterial. Survival analysis followed by multivariate Cox regression with an estimation of hazard ratios (HR) with 95% confidence intervals (95%CI) was performed.

Results

We included 259 patients during a mean follow-up of 23.3 ± 5.7 months. The incidence rate of infection of any type was 59.3 cases per 100 patient-years. Multivariate Cox models showed that (a) prednisolone ≥ 7.5 mg/day (HR = 1.95, 95%CI 1.26–3.03) and female gender (HR = 2.08, 95%CI 1.12–3.86) were associated with higher risk of infection of any type; (b) prednisolone ≥ 10 mg/day was associated with higher (HR = 4.32, 95%CI 1.39–13.40), and antimalarials with lower risk (HR = 0.18, 95%CI 0.06–0.51) of serious infection; (c) female gender (HR = 1.92, 95%CI 1.04–3.57) and prednisolone ≥ 7.5 mg/day (HR = 1.89, 95%CI 1.21–2.96) were associated with higher risk of non-serious infection; (d) antimalarials were associated with lower (HR = 0.49, 95%CI 0.26–0.93) and female gender (HR = 5.12; 95%CI 1.62–16.18) with higher risk of bacterial infection.

Conclusions

The risk of infection was higher in females in this young, well-controlled, low-comorbidity SLE cohort. Antimalarials were associated with lower and prednisolone ≥ 7.5 mg with higher risk of infection.

Key Points

• Lupus patients treated with prednisolone ≥ 7.5 mg/day were 89% more likely to present infections.

• Lupus patients receiving prednisolone ≥ 10 mg/day were four times more likely to present serious infections.

• Lupus patients receiving antimalarials were 82% less likely to present serious infections.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Rheumatology Unit, Hospitais da Universidade de Coimbra-Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

    Ana Rita Prata, Mariana Luís, Helena Assunção, José António Pereira da Silva & Luís Sousa Inês

  2. Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    Mariana Luís & José António Pereira da Silva

  3. Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal

    Luís Sousa Inês

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  1. Ana Rita Prata
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  2. Mariana Luís
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  4. José António Pereira da Silva
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  5. Luís Sousa Inês
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Contributions

AP was involved in the bibliographic research, data collection, statistical analysis, interpretation of the data, and manuscript drafting. ML was involved in the data collection and manuscript review. HA and JAP da Silva were involved in the manuscript review. LI was involved in the bibliographic research, conception, and design of the study, statistical analysis, interpretation of the data, and manuscript review. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Ana Rita Prata.

Ethics declarations

Ethics approval and consent to participate

This project was conducted according to the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Centro Hospitalar e Universitário de Coimbra (protocol number CHUC04618). All patients signed an informed consent form before the inclusion in this study.

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Not applicable.

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A part of this manuscript has been published as an abstract in Lupus Science & Medicine (Prata A, Luís M, Assunção H, Inês L. P154 Antimalarial Treatment and Minimizing Prednisone Reduce The Risk of Infection in SLE Patients: a 24-Month Prospective Cohort Study. 2020;7 (Suppl 1):A105.1-A105).

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Prata, A.R., Luís, M., Assunção, H. et al. Antimalarial treatment and minimizing prednisolone are associated with lower risk of infection in SLE: a 24-month prospective cohort study. Clin Rheumatol 41, 1069–1078 (2022). https://doi.org/10.1007/s10067-021-05988-x

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