Evaluation of Low Dose Glucocorticoid Effects on Infection Occurrence in Systemic Lupus Erythematosus Patients

Kazuya Abe¹, Nobuyuki Yajima², Yuichi Ishikawa³, Yasuhiko Kita⁴, Ken-ei Sada⁵, Ryusuke Yoshimi⁶, Yasuhiro Shimojima⁷, Shigeru Ohno⁸, Hiroshi Kajiyama⁹, Kunihiro Ichinose¹⁰, Shuzo Sato¹¹ and Michio Fujiwara¹², ¹Department of Rheumatology, Yokohama Rosai Hospital, Chiba, Japan, ²Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan, ³Department of Rheumatology, Yokohama Rosai Hospital, Tokyo, Japan, ⁴Department of Rheumatology, Yokohama Rosai Hospital, kanagawa, ⁵Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan, ⁶Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan, ⁷Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan, ⁸Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan, ⁹Department of Rheumatology and Applied Immunology Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan, ¹⁰Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan, ¹¹Fukushima Medical University School of Medicine, Department of Rheumatology, Fukushima, Japan, ¹²Department of Rheumatology, Yokohama Rosai Hospital, Kanagawa, Japan

Meeting: ACR Convergence 2020

Keywords: glucocorticoids, Infection, Systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 9, 2020

Title: SLE – Treatment Poster II

Session Type: Poster Session D

Session Time: 9:00AM-11:00AM

Background/Purpose: Infection is major cause of morbidity and mortality in systemic lupus erythematosus (SLE) patient. The past exploratory study suggested various infection risk in SLE patients, such as administration of higher than 7.5mg prednisolone daily or equivalent, high disease activity of SLE, therapy of intravenous administration of cyclophosphamide and leukocytopenia. High dose glucocorticoids (GCs) administration is known to increase the risk of infection in SLE patients; however, the risk of infection in SLE patients receiving low-dose GCs remains unclear. In this study, we evaluated the risk of severe infection requiring hospitalization in SLE patients receiving low-dose GCs as remission maintenance therapy.

Methods: Study design was prospective cohort study. We enrolled SLE patients who fulfilled standardized SLE criteria and could follow up more than a year using the database from multicenter registries of SLE patients in Japan (Lupus registry of nationwide institutions: LUNA). We exclude the patients who are in the induction remission therapy phase (PSL >15mg or equivalent). We extracted data on the patient’s sex, age, daily GC doses, and comorbidities that could potentially affect the infection occurrence. Our main exposure was the daily GC doses at the onset of infection. We divided the daily GC doses into four categories; 0-2.5mg of PSL or equivalent doses, 2.6-5.0mg, 5.1-7.5mg, and 7.6-15mg. Outcome measurement was infection occurrence that needed hospitalization. We used logistic regression model to analyze the correlation between GC doses and infection occurrence with adjustment for age, sex, immunosuppressants.

Results: Two hundred ninety patients were enrolled, and the mean age of patients was 47.3 years. The female rates were 88%, immunosuppressants were used in 44% of patients, the mean SLE disease activity index was 5.8 and diabetes mellitus patients were 4%. The overall infection occurrence was 57 events. In each group, 3 of 68 patients in PSL 0-2.5mg group, 28 of 111 patients in PSL 2.6-5.0mg group, 9 of 51 patients in PSL 5.1-7.5mg group, 17 of 60 patients in PSL 7.6-15mg group developed an infection. Compared with PSL 0-2.5mg group, the odds ratio for the development of infection was 8.0 (95% confidence interval (CI), 2.29-28.0) in PSL 2.6-5.0mg group, 5.3 (95% CI, 1.29-21.8) in PSL 5.1-7.5mg group, and 11.2 (95% CI, 2.92-43.0) in PSL 7.6-15mg group.

Conclusion: Even when relatively low doses of PSL are administered to patients with SLE in the maintenance phase, the risk of infection may remain.

Disclosure: K. Abe, None; N. Yajima, None; Y. Ishikawa, None; Y. Kita, None; K. Sada, None; R. Yoshimi, None; Y. Shimojima, None; S. Ohno, None; H. Kajiyama, None; K. Ichinose, None; S. Sato, None; M. Fujiwara, None.

To cite this abstract in AMA style:

Abe K, Yajima N, Ishikawa Y, Kita Y, Sada K, Yoshimi R, Shimojima Y, Ohno S, Kajiyama H, Ichinose K, Sato S, Fujiwara M. Evaluation of Low Dose Glucocorticoid Effects on Infection Occurrence in Systemic Lupus Erythematosus Patients [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/evaluation-of-low-dose-glucocorticoid-effects-on-infection-occurrence-in-systemic-lupus-erythematosus-patients/. Accessed .

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