Corticosteroid dose and the risk of opportunistic infection in a national systemic lupus erythematosus cohort

• Published in: Lupus 2018-10, Vol.27 (11), p.1819-1827
• Main Authors: Yang, S-C, Lai, Y-Y, Huang, M-C, Tsai, C-S, Wang, J-L
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adult; Aged; Cohort Studies; Comorbidity; Corticosteroids; Diagnosis; Dose-Response Relationship, Drug; Female; Health risk assessment; Herpes zoster; Herpes Zoster - epidemiology; Humans; Immunosuppressive agents; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Incidence; Infections; Logistic Models; Lupus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Male; Middle Aged; Opportunist infection; Opportunistic Infections - epidemiology; Prednisone; Proportional Hazards Models; Risk Factors; Steroid hormones; Steroids; Systemic lupus erythematosus; Taiwan - epidemiology; Young Adult
• ISSN: 0961-2033; 1477-0962
• DOI: 10.1177/0961203318792352

Objective This study investigated whether the incidence of opportunistic infection differed in systemic lupus erythematosus patients who received different doses of corticosteroids. Methods We included patients with diagnosed systemic lupus erythematosus from 1997 to 2010 using Taiwan national health insurance data. The index day for systemic lupus erythematosus patients was 3 months after the systemic lupus erythematosus diagnosis. A non-steroid cohort was matched 4:1 with the steroid cohort according to age, sex and index day. The end of the follow-up period was the day of opportunistic infection diagnosis, 1 year after the index day, or death. Results The overall cumulative incidence of opportunistic infection was 136-fold higher in the steroid cohort than in the non-steroid cohort. The adjusted hazard ratio for developing mycobacterium infection in the steroid cohort was 11, and the adjusted hazard ratio for developing herpes zoster was 43.6 compared to the non-steroid cohort after adjusting for immunosuppressive agents and comorbidities. The adjusted hazard ratio value for opportunistic infection was 1.40 (95% confidence interval (CI) 0.78–2.51) for a daily prednisone-equivalent dose of 7.5–15 mg, 1.72 (95% CI 1.02–2.91) for 15–30 mg, 1.96 (95% CI 1.17–3.28) for 30–60 mg and 2.24 (95% CI 1.26–4.00) for over 60 mg compared with low-dose steroids (