Risk of serious infections with immunosuppressive drugs and glucocorticoids for lupus nephritis: a systematic review and network meta-analysis

Singh, Jasvinder A.; Hossain, Alomgir; Kotb, Ahmed; Wells, George

doi:10.1186/s12916-016-0673-8

Cited by 131 publications

(97 citation statements)

References 40 publications

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“…Previous studies showed disease activity，high anti‐dsDNA titers, low complement levels, nephritis, leucopenia, GC doses and immunosuppressants were risk factors for infections in lupus patients . A nationwide cohort of SLE patients showed that male sex and Black race were risks factors for infection, whereas hydroxychloroquine was a protective factor …”

Section: Discussionmentioning

confidence: 97%

Mortality prediction in systemic lupus erythematosus patients with pulmonary infection

et al. 2019

Int J of Rheum Dis

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Objective: The impact of pulmonary infection (PI) on mortality of patients with systemic lupus erythematosus (SLE) has been established. Nevertheless, the effect of risk factors in mortality remains controversial. The objective of this study is to determine the risk factors of short-term mortality among SLE patients with PI. Method:The clinical data of 54 SLE patients with 59 episodes of PI who were hospitalized from January 2013 to May 2018 was retrospectively analyzed. Demographic data, clinical features, and outcomes were collected. Logistic regression analysis was carried out to determine the independent predictors of 60-day mortality during hospitalization. We used receiver operating characteristics (ROC) curves to verify the indices as mortality predictors in the study patients.Results: There were a total of 54 patients with 59 episodes of PI. There were 12 deaths during hospitalization. In multivariate analysis, 24-hour urinary protein (24h-PRO) (odds ratio [OR]: 2.713, 95% CI: 1.234-5.965, P = 0.013), peripheral lymphocyte count (OR: 0.066, 95% CI: 0.005-0.887, P = 0.040), and serum complement 3 level (C3) (OR: 0.097, 95% CI: 0.010-0.954, P = 0.045) were associated with mortality among our cohort of SLE patients with PI. ROC curve values were 0.818 for lymphocyte count (95% CI: 0.696-0.907, P = 0.001), 0.894 for 24h-PRO (95% CI: 0.786-0.959, P < 0.001) and 0.825 for C3 (95% CI: 0.704-0.912, P = 0.001). The cut-off value of lymphocytes, 24h-PRO and C3 were 0.53 × 10 9 /L, 0.92 g and 0.52 g/L, respectively. Conclusion:The presence of albuminuria, lymphopenia and low complement C3 levels were independent prognostic predictors of short-term mortality in SLE patients with PI. K E Y W O R D S lupus erythematosus-systemic, mortality, pulmonary infection How to cite this article: prediction in systemic lupus erythematosus patients with pulmonary infection. Int J Rheum Dis.

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Section: Discussionmentioning

confidence: 97%

Mortality prediction in systemic lupus erythematosus patients with pulmonary infection

et al. 2019

Int J of Rheum Dis

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“…Our data at the least suggest that the use of TAC is not inferior to conventional treatment. Moreover, we and others27 28 32 showed that the safety profile of TAC is very good in LN. Therefore, we would recommend TAC to be considered as a treatment option in patients with refractory LN.…”

Section: Discussionmentioning

confidence: 73%

TAC-TIC use of tacrolimus-based regimens in lupus nephritis

et al. 2016

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Current guidelines do not mention tacrolimus (TAC) as a treatment option and no consensus has been reported on the role of TAC in lupus nephritis (LN). The present study aimed to guide clinical judgement on the use of TAC in patients with LN. A meta-analysis was performed for clinical studies investigating TAC regimens in LN on the basis of treatment target (induction or maintenance), concomitant immunosuppression and quality of the data. 23 clinical studies performed in patients with LN were identified: 6 case series, 9 cohort studies, 2 case-control studies and 6 randomised controlled trials (RCTs). Of the 6 RCTs, 5 RCTs investigated TAC regimens as induction treatment and 1 RCT as maintenance treatment. Five RCTs investigated TAC in combination with steroids and 2 TAC with mycophenolate plus steroids. All RCTs were performed in patients of Asian ethnicity. In a meta-analysis, TAC regimens achieved a significantly higher total response (relative risk (RR) 1.23, 95% CI 1.12 to 1.34, p<0.05) and significantly higher complete response (RR 1.48, 95% CI 1.23 to 1.77, p<0.05). The positive outcome was predominantly defined by the largest RCT investigating TAC with mycophenolate plus steroids. Regarding safety, the occurrence of leucopoenia was significantly lower, while the occurrence of increased creatine was higher. Clinical studies on TAC regimens for LN are limited to patients of Asian ethnicity and hampered by significant heterogeneity. The positive results on clinical efficacy of TAC as induction treatment in LN cannot be extrapolated beyond Asian patients with LN. Therefore, further confirmation in multiethnic, randomised trials is mandatory. Until then, TAC can be considered in selected patients with LN.

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“…The high frequency of functional bloating found in our SLE patients was also reported in an Asian study among patients with rheumatic disorders . Another potential explanation for the higher frequency of FGIDs in SLE patients may be that these patients may be immunosuppressed, which could predispose them to enteric infections . The role of gastrointestinal infections as trigger factors for postinfection disorders such as IBS has been described .…”

Section: Discussionmentioning

confidence: 99%

Functional gastrointestinal disorders in women with systemic lupus erythematosus: A case‐control study

Garcı́a-Carrasco

Mendoza‐Pinto

Munguía‐Realpozo

et al. 2019

Neurogastroenterology Motil

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Background Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystemic involvement. Gastrointestinal (GI) manifestations are frequent but functional gastrointestinal disorders (FGIDs) have scarcely been studied in SLE. To determine the prevalence of FGIDs and their potential risk factors in SLE female patients vs controls. Methods Systemic lupus erythematosus patients meeting the American College of Rheumatology (ACR) criteria and controls completed the Rome III questionnaire for FGIDs and a structured interview to assess sociodemographic, clinical, and treatment variables after excluding organic GI diseases. Logistic regression was used to determine risk factors (ie, alcohol drinking, medications) for FGIDs. Key Results Responders included 113 SLE patients and 122 age‐matched controls. The presence of at least one FGIDs was higher in SLE (73.4%) vs controls (54.1%), P = .003. The most frequent FGIDs in SLE patients were nausea and vomiting disorders (NVD), belching disorders, globus, anorectal pain, functional heartburn (FH), and functional bloating (FB). After adjustment for confounding variables, SLE was associated with NVD (OR: 7.1, 95% CI: 2.7‐19.1) globus (3.5, 1.3‐9.3), anorectal pain (3.4, 1.4‐8.4), and FH (2.5, 1.5‐4.4). The simultaneous presence of >1 FGID was more common in SLE patients than controls (69.8% vs 31.8%). Glucocorticoids (5.2, 1.3‐19.9) and non‐steroidal anti‐inflammatory drugs (NSAIDs; 3.0, 1.1‐8.0) were associated with any FGID in SLE patients while alcohol drinking with gallbladder/sphincter of Oddi disorders 7.4 (1.1‐47.3). Conclusions and Inferences Functional gastrointestinal disorders are more frequent in SLE patients compared with controls. Medication that may alter gastrointestinal homeostasis, such as glucocorticoids and NSAIDs, are potential risk factors for FGIDs in SLE.

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Risk of serious infections with immunosuppressive drugs and glucocorticoids for lupus nephritis: a systematic review and network meta-analysis

Cited by 131 publications

References 40 publications

Mortality prediction in systemic lupus erythematosus patients with pulmonary infection

Mortality prediction in systemic lupus erythematosus patients with pulmonary infection

TAC-TIC use of tacrolimus-based regimens in lupus nephritis

Functional gastrointestinal disorders in women with systemic lupus erythematosus: A case‐control study

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