TY - JOUR T1 - Assessment of Risks of Pulmonary Infection During 12 Months Following Immunosuppressive Treatment for Active Connective Tissue Diseases: A Large-scale Prospective Cohort Study JF - The Journal of Rheumatology JO - J Rheumatol SP - 614 LP - 622 DO - 10.3899/jrheum.140778 VL - 42 IS - 4 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 Y1 - 2015/04/01 UR - http://www.jrheum.org/content/42/4/614.abstract N2 - 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. ER -