RT Journal Article
SR Electronic
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
FD The Journal of Rheumatology
SP jrheum.140778
DO 10.3899/jrheum.140778
A1 Hayato Yamazaki
A1 Ryoko Sakai
A1 Ryuji Koike
A1 Yasunari Miyazaki
A1 Michi Tanaka
A1 Toshihiro Nanki
A1 Kaori Watanabe
A1 Shinsuke Yasuda
A1 Takashi Kurita
A1 Yuko Kaneko
A1 Yoshiya Tanaka
A1 Yasuhiko Nishioka
A1 Yoshinari Takasaki
A1 Kenji Nagasaka
A1 Hayato Nagasawa
A1 Shigeto Tohma
A1 Makoto Dohi
A1 Takahiko Sugihara
A1 Haruhito Sugiyama
A1 Yasushi Kawaguchi
A1 Naohiko Inase
A1 Sae Ochi
A1 Hiroyuki Hagiyama
A1 Hitoshi Kohsaka
A1 Nobuyuki Miyasaka
A1 Masayoshi Harigai
YR 2015
UL http://www.jrheum.org/content/early/2015/01/27/jrheum.140778.abstract
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.