PT  - JOURNAL ARTICLE
AU  - Hayato Yamazaki
AU  - Ryoko Sakai
AU  - Ryuji Koike
AU  - Yasunari Miyazaki
AU  - Michi Tanaka
AU  - Toshihiro Nanki
AU  - Kaori Watanabe
AU  - Shinsuke Yasuda
AU  - Takashi Kurita
AU  - Yuko Kaneko
AU  - Yoshiya Tanaka
AU  - Yasuhiko Nishioka
AU  - Yoshinari Takasaki
AU  - Kenji Nagasaka
AU  - Hayato Nagasawa
AU  - Shigeto Tohma
AU  - Makoto Dohi
AU  - Takahiko Sugihara
AU  - Haruhito Sugiyama
AU  - Yasushi Kawaguchi
AU  - Naohiko Inase
AU  - Sae Ochi
AU  - Hiroyuki Hagiyama
AU  - Hitoshi Kohsaka
AU  - Nobuyuki Miyasaka
AU  - Masayoshi Harigai
TI  - Assessment of Risks of Pulmonary Infection During 12 Months Following Immunosuppressive Treatment for Active Connective Tissue Diseases: A Large-scale Prospective Cohort Study
AID  - 10.3899/jrheum.140778
DP  - 2015 Apr 01
TA  - The Journal of Rheumatology
PG  - 614--622
VI  - 42
IP  - 4
4099  - http://www.jrheum.org/content/42/4/614.short
4100  - http://www.jrheum.org/content/42/4/614.full
SO  - J Rheumatol2015 Apr 01; 42
AB  - Objective. Pulmonary infections (PI) are leading causes of death in patients with connective tissue diseases (CTD). The PREVENT study (Pulmonary infections in patients REceiving immunosuppressiVE treatmeNT for CTD) assessed risk of PI in patients with active CTD in the contemporary era of advanced immunosuppressive therapy. Methods. In patients who started corticosteroids (n = 763), conventional immunosuppressants or biologics for active CTD were enrolled. Clinical and laboratory data, usage of drugs, and occurrence of PI were collected for 12 months. Baseline risk factors were investigated using Cox regression analysis. A nested case-control (NCC) study was performed with 1:2 matched case-control pairs to assess the risk for each drug category. Results. During the observation period, 32 patients died (4.2%) and 66 patients were lost to followup (8.6%). Patients with PI (n = 61, 8%) had a significantly worse accumulated survival rate than patients without (p < 0.01). Cox hazard regression analysis using baseline data showed that these factors were significantly associated with PI: age ≥ 65 years (HR 3.87, 95% CI 2.22–6.74), ≥ 20 pack-years of smoking (2.63, 1.37–5.04), higher serum creatinine level (1.21, 1.05–1.41 per 1.0 mg/dl increase), and maximum prednisolone (PSL) dose during the first 2 weeks of treatment (2.81, 1.35–5.86 per 1.0 mg/kg/day increase). Logistic regression analysis by an NCC study revealed that maximum PSL dose within 14 days before PI (OR 4.82, 95% CI 1.36–17.01 per 1.0 mg/dl increase; 2.57, 1.28–5.16 if ≥ 0.5 mg/kg/day) was significantly associated with the events, while other immunosuppressants were not. Conclusion. Physicians should be aware of the higher risks for corticosteroids of PI than other immunosuppressants and assess these risk factors before immunosuppressive treatment, to prevent PI.