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Corticosteroids may increase lung infection risk in patients with connective tissue diseases
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Patients with connective tissue diseases, particularly those who were older, smokers, male and received maximum dosage, treated with prednisolone or other corticosteroids were at higher risk for pulmonary infections, according to researchers from the PREVENT study group.
The researchers studied 763 patients with connective tissue diseases (CTD) including systemic lupus erythematosus, rheumatoid arthritis, vasculitis, polymyositis or dermatomyositis from 10 university hospitals and one referring hospital in Japan. Demographics collected included risk factors for pulmonary infection, such as smoking status. Patients were treated with one or a combination of prednisolone or other corticosteroids, methylprednisolone pulse therapy, conventional immunosuppressants or biologics and observed at baseline before treatment and at 6 and 12 months after starting treatment.
Sixty-one participants developed pulmonary infections. At baseline, age of 65 years and older, 20 or more pack-years of smoking, serum creatinine and maximum prednisolone dose during the first 14 days of treatment were significantly associated with the development of pulmonary infection, and fewer women were in the infection group, according to the researchers. Bacterial pneumonia was seen in 25 patients who developed infection (41%), and 20 (32.8%) developed Pneumocystis jirovecci.
Cox regression models identified age of 65 years and older, incident use of immunosuppressive therapy, 20 or more pack-years of smoking, serum creatinine levels and maximum prednisolone dosage during the first 14 days of treatment as higher risks for developing pulmonary infections. More than half of patients developed infections in the first 3 months of therapy, according to the researchers. – by Shirley Pulawski
Disclosure: The study was supported by grants for pharmacovigilance research on biologics from Abbvie G.K., Astellas Co. Ltd., Bristol-Myers Squibb Japan, Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Mitsubishi Tanabe Pharma Corp., and Takeda Pharmaceutical Co. Ltd. Please see the full study for a list of all other authors’ relevant financial disclosures.
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