The following is a summary of “Risk Factors and Incidence of Serious Infections in Patients With Systemic Lupus Erythematosus Undergoing Rituximab Therapy,” published in the February 2024 issue of Rheumatology by Sun et al.
Researchers conducted a retrospective study to assess risk and protective factors for serious infections (SI) in systemic lupus erythematosus (SLE) patients within 180 days post-rituximab (RTX) treatment.
They analyzed SLE patients receiving RTX, defining SI as any infectious disease necessitating hospitalization. They examined clinical characteristics, laboratory profiles, medications, and incidence rates (IR), followed by multivariate Cox proportional hazards models and Kaplan-Meier analysis to identify SI risk factors.
The results showed that of 174 SLE patients receiving RTX treatment, the overall IR) of SIs was 51.0 per 100 patient-years (PYs). Pneumonia (30.4/100 PYs) was the most common SI, with soft tissue infections, intra-abdominal infections, and Pneumocystis jiroveci pneumonia (all 6.1/100 PYs). 12 patients died during the 180-day follow-up (crude mortality rate: 14.6/100 PYs). Chronic kidney disease (CKD), defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 (HR 2.88, 95% CI 1.30-6.38), and a background prednisolone (PSL) equivalent dosage ≥ 15 mg/day (HR 3.50, 95% CI 1.57-7.78) were identified as risk factors for SIs among all SLE patients. Kaplan-Meier analysis confirmed the increased SI risk for SLE patients with CKD and a background PSL equivalent dosage ≥ 15 mg/day (log-rank P=0.001 and 0.02). Hydroxychloroquine (HCQ) was associated with a reduced SI risk in SLE patients (HR 0.35, 95% CI 0.15-0.82; log-rank P=0.003).
Investigators concluded that RTX increased SI in SLE patients, especially those with kidney issues and high steroid use. HCQ might offer protection.
Source: jrheum.org/content/51/2/160