Jordan E Roberts, Anna V Faino, Marshall Brown, Gabrielle Alonzi, Mersine A Bryan, Cordelia Burn, Joyce C Chang, Jonathan D Cogen, Nidhi Naik, Kareena Patel, Emily Zhang, Esi M Morgan, MaryBeth Son
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Hospitalised infection frequency was calculated over the first year of treatment in youth included in each DMARD exposure group, stratified by lupus nephritis (LN) status. Cox proportional hazard regression with inverse probability of treatment weighting (IPTW) was used to compare infection rates across DMARD groups, adjusting for corticosteroid dose.</p><p><strong>Results: </strong>Among 257 youths with cSLE, 5% had ≥1 hospitalised infection within 1 year of DMARD initiation. 8% of those with LN had ≥1 hospitalised infection compared with 2.5% without LN. In IPTW-adjusted models, children with LN treated with mycophenolate had lower risk of infection compared with those treated with cyclophosphamide (HR 0.12; 95% CI 0.019 to 0.88). Among those without LN, mycophenolate did not differ from azathioprine in infection risk (HR 1.67, 95% CI 0.56 to 4.99). Higher oral corticosteroid dosing (per 1 mg/day of prednisone) was associated with increased risk of infection (HR 1.1, 95% CI 1.05 to 1.15).</p><p><strong>Conclusions: </strong>We observed higher hospitalised infection rates in children with cSLE and LN compared with those without LN. Among children with LN, those who received cyclophosphamide had more infections than those who received mycophenolate. Methotrexate was associated with lower infection rates than mycophenolate or azathioprine among youth without LN. 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引用次数: 0
摘要
目的：儿童期SLE （cSLE）青少年严重感染的风险增加。目前尚不清楚这种风险有多少是由于可改变的因素，如免疫抑制剂的选择。我们的目的是比较不同疾病改善抗风湿药物（DMARDs）在青年cSLE患者的住院感染率。方法：我们纳入了2009年至2022年在两个中心治疗的≤18岁的cSLE青年。临床数据提取自电子健康记录和儿科健康信息系统。根据狼疮性肾炎（LN）状态分层，计算每个DMARD暴露组中青年治疗第一年的住院感染频率。采用治疗加权逆概率（IPTW）的Cox比例风险回归来比较DMARD组的感染率，并调整皮质类固醇剂量。结果：257名青少年cSLE患者中，5%在开始使用DMARD的1年内有≥1次住院感染。8%的LN患者有≥1次住院感染，而非LN患者为2.5%。在iptw校正的模型中，与环磷酰胺治疗相比，接受霉酚酸酯治疗的LN儿童感染风险较低（HR 0.12; 95% CI 0.019至0.88）。在没有LN的患者中，霉酚酸酯与硫唑嘌呤在感染风险上没有差异（HR 1.67, 95% CI 0.56 - 4.99）。较高的口服皮质类固醇剂量（每1毫克/天强的松）与感染风险增加相关（HR 1.1, 95% CI 1.05 - 1.15）。结论：我们观察到患有cSLE和LN的儿童的住院感染率高于没有LN的儿童。在患有LN的儿童中，接受环磷酰胺治疗的儿童比接受霉酚酸盐治疗的儿童感染更多。在没有LN的年轻人中，甲氨蝶呤的感染率低于霉酚酸酯或硫唑嘌呤。较高的每日口服类固醇剂量与非肾性SLE患者住院感染风险增加显著相关。
Association of disease-modifying antirheumatic drug selection with hospitalised infection among youth with childhood-onset systemic lupus erythematosus.
Objective: Youth with childhood-onset SLE (cSLE) have increased risk of serious infection. It is unknown how much of this risk is due to modifiable factors such as choice of immunosuppressant. We aimed to compare hospitalised infection rates in youth with cSLE on different disease-modifying antirheumatic drugs (DMARDs).
Methods: We included youth ≤18 years with cSLE treated from 2009 to 2022 at two centres. Clinical data were extracted from electronic health records and the Paediatric Health Information System. Hospitalised infection frequency was calculated over the first year of treatment in youth included in each DMARD exposure group, stratified by lupus nephritis (LN) status. Cox proportional hazard regression with inverse probability of treatment weighting (IPTW) was used to compare infection rates across DMARD groups, adjusting for corticosteroid dose.
Results: Among 257 youths with cSLE, 5% had ≥1 hospitalised infection within 1 year of DMARD initiation. 8% of those with LN had ≥1 hospitalised infection compared with 2.5% without LN. In IPTW-adjusted models, children with LN treated with mycophenolate had lower risk of infection compared with those treated with cyclophosphamide (HR 0.12; 95% CI 0.019 to 0.88). Among those without LN, mycophenolate did not differ from azathioprine in infection risk (HR 1.67, 95% CI 0.56 to 4.99). Higher oral corticosteroid dosing (per 1 mg/day of prednisone) was associated with increased risk of infection (HR 1.1, 95% CI 1.05 to 1.15).
Conclusions: We observed higher hospitalised infection rates in children with cSLE and LN compared with those without LN. Among children with LN, those who received cyclophosphamide had more infections than those who received mycophenolate. Methotrexate was associated with lower infection rates than mycophenolate or azathioprine among youth without LN. Higher daily oral steroid dose was significantly associated with increased hospitalised infection risk in youth with non-renal SLE.
期刊介绍：
Lupus Science & Medicine is a global, peer reviewed, open access online journal that provides a central point for publication of basic, clinical, translational, and epidemiological studies of all aspects of lupus and related diseases. It is the first lupus-specific open access journal in the world and was developed in response to the need for a barrier-free forum for publication of groundbreaking studies in lupus. The journal publishes research on lupus from fields including, but not limited to: rheumatology, dermatology, nephrology, immunology, pediatrics, cardiology, hepatology, pulmonology, obstetrics and gynecology, and psychiatry.
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