Serious infections prevalent in RTX-treated patients with SLE

A recent study has reported the prevalence of serious infection (SI) among patients with systemic lupus erythematosus (SLE) following treatment with rituximab (RTX).

The authors analysed 174 SLE patients receiving RTX treatment. SI referred to any infectious disease requiring hospitalization. The clinical characteristics, laboratory profiles, medications, and incidence rate (IR) of these participants were reported.

Finally, the authors used multivariate Cox proportional hazards models and performed Kaplan-Meier analysis to determine the risk factors for SI.

The overall IR of SIs was 51.0 per 100 patient-years (PYs). The most common type of SI was pneumonia (30.4 per 100 PYs), followed by soft tissue infections, intra-abdominal infections, and Pneumocystis jiroveci pneumonia (6.1 per 100 PYs for all). During the 180-day follow-up, 12 patients died (crude mortality rate, 14.6 per 100 PYs).

Among patients with SLE, the risk of SIs was higher among those with chronic kidney disease (CKD), defined as an estimated glomerular filtration rate <60 mL/min/1.73 m² (hazard ratio [HR], 2.88, 95 percent confidence interval [CI], 1.30‒6.38), and a background prednisolone (PSL) equivalent dosage ≥15 mg/day (HR, 3.50, 95 percent CI, 1.57‒7.78).

These findings were confirmed in Kaplan-Meier analysis: SLE patients with CKD (log-rank p=0.001) and a background PSL equivalent dosage ≥15 mg/day (log-rank p=0.02).

Notably, use of hydroxychloroquine (HCQ) led to a decrease in SI risk in SLE patients (HR, 0.35, 95 percent CI, 0.15‒0.82; log-rank p=0.003).

“Patients with SLE with CKD and high-dose glucocorticoid use required constant vigilance,” the authors said. “HCQ may reduce the risk of SI among patients with SLE administered RTX.”