Lupus patients at high risk of infection

Systemic lupus erythematosus (SLE) carries a heightened risk of infection, according to a study.

Researchers conducted a systematic review and meta-analysis of studies that evaluated infection risk in patients with SLE relative to the general population or healthy controls. They pooled data from 11 studies, of which seven were conducted in Europe, North America, Asia, Middle East, and South America.

Study periods ranged between <1 year and 45 years, with outcomes including fatal and/or nonfatal events. The total population included 469,570 patients with SLE and 6,528,441 non-SLE/general population/healthy controls. Participants’ age ranged from 34.8 to 63.5 years.

Outcomes included overall severe infection (n=4), pneumonia (n=6), tuberculosis (n=3), and herpes zoster (n=2). Compared with controls, SLE patients had a significantly greater risk of overall severe infection (risk ratio [RR], 2.96, 95 percent confidence interval [CI], 1.28–6.83).

The same was true for pneumonia (RR, 2.58, 95 percent CI, 1.80–3.70), herpes zoster (RR, 2.50, 95 percent CI, 2.36–2.65), and tuberculosis (RR, 6.11, 95 percent CI, 3.61–10.33).

Heterogeneity and evidence of publication bias were observed for all analyses, with the exception of herpes zoster. Sensitivity analyses confirmed robustness of the results.

In light of the findings, strategies aimed at prevention of infections in these patients should be strengthened, such as counselling on preventative measures, vaccinations, use of hydroxychloroquine, or reduction of the dosage, and duration of glucocorticoids and immunosuppressants.