Hydroxychloroquine may reduce risk of Pneumocystis pneumonia in lupus patients: a Nationwide, population-based case-control study
Identifieur interne : 000042 ( Pmc/Curation ); précédent : 000041; suivant : 000043Hydroxychloroquine may reduce risk of Pneumocystis pneumonia in lupus patients: a Nationwide, population-based case-control study
Auteurs : Kai-Jieh Yeo [Taïwan] ; Hsin-Hua Chen [Taïwan] ; Yi-Ming Chen [Taïwan] ; Ching-Heng Lin [Taïwan] ; Der-Yuan Chen [Taïwan] ; Chih-Ming Lai [Taïwan] ; Wen-Cheng Chao [Taïwan]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2020.
Abstract
Pneumocystis pneumonia (PCP) is increasingly being diagnosed in patients with systemic lupus erythematosus (SLE), and hydroxychloroquine (HCQ) has been found to possess antifungal activities. We hence aimed to investigate the association between HCQ and PCP risk among patients with SLE.
Using the 1997–2013 nationwide claim data, we identified 24,343 newly-diagnosed SLE patients. We then identified 58 PCP cases and selected 348 non-PCP controls matching (1:6) by age, sex, disease duration and the year of PCP diagnosis date. The risk of PCP was assessed by determing odds ratios (ORs) with 95% confidence intervals (CIs) by using multivariable conditional logistic regression.
The risk of PCP was associated with moderate to severe renal disease (OR 6.73, 95% CI 1.98–22.92), higher doses of glucocorticoids (≤5 mg/day, reference; 5–10 mg/day, OR 25.88, 95% CI 2.97–225.33; > 10 mg/day, OR 286.58, 95% CI 28.58–> 999), higher 3-month cumulative dose of cyclophosphamide (not use, reference; ≤1.4 g, OR 0.64, 95% CI 0.14–3.01; > 1.4 g, OR 11.52, 95% CI 1.97–67.39) and use of mycophenolate mofetil/mycophenolic acid (OR 50.79, 95% CI 5.32–484.77), whereas 3-month cumulative dose of HCQ was associated with a reduced risk of PCP among patients with SLE (not use, reference; ≤14 g, OR 0.69, 95% CI 0.21–2.24; > 14 g, OR 0.20, 95% CI 0.05–0.71).
This study demonstrated incident PCP was associated with mycophenolate mofetil/mycophenolic acid use and higher doses of cyclophosphamide or glucocorticoid, whereas the use of a higher dose of HCQ was associated with a reduced risk of PCP in lupus patients.
Url:
DOI: 10.1186/s12879-020-4826-1
PubMed: 32041539
PubMed Central: 7011312
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Hydroxychloroquine may reduce risk of Pneumocystis pneumonia in lupus patients: a Nationwide, population-based case-control study</title>
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</affiliation>
</author>
<author><name sortKey="Chen, Der Yuan" sort="Chen, Der Yuan" uniqKey="Chen D" first="Der-Yuan" last="Chen">Der-Yuan Chen</name>
<affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0572 9415</institution-id>
<institution-id institution-id-type="GRID">grid.411508.9</institution-id>
<institution>Rheumatology and Immunology Center,</institution>
<institution>China Medical University Hospital,</institution>
</institution-wrap>
Taichung, Taiwan</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Taichung</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff10"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0572 9415</institution-id>
<institution-id institution-id-type="GRID">grid.411508.9</institution-id>
<institution>Translational Medicine Laboratory, Rheumatic Diseases Research Center,</institution>
<institution>China Medical University Hospital,</institution>
</institution-wrap>
Taichung, Taiwan</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Taichung</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff11"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0083 6092</institution-id>
<institution-id institution-id-type="GRID">grid.254145.3</institution-id>
<institution>School of Medicine,</institution>
<institution>China Medical University,</institution>
</institution-wrap>
Taichung, Taiwan</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Taichung</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Lai, Chih Ming" sort="Lai, Chih Ming" uniqKey="Lai C" first="Chih-Ming" last="Lai">Chih-Ming Lai</name>
<affiliation wicri:level="1"><nlm:aff id="Aff12"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0573 0731</institution-id>
<institution-id institution-id-type="GRID">grid.410764.0</institution-id>
<institution>Department of Critical Care Medicine,</institution>
<institution>Taichung Veterans General Hospital,</institution>
</institution-wrap>
Taichung, Taiwan</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Taichung</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff13"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0573 0731</institution-id>
<institution-id institution-id-type="GRID">grid.410764.0</institution-id>
<institution>Department of Neurosurgery,</institution>
<institution>Neurological Institute, Taichung Veterans General Hospital,</institution>
</institution-wrap>
Taichung, Taiwan</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Taichung</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Chao, Wen Cheng" sort="Chao, Wen Cheng" uniqKey="Chao W" first="Wen-Cheng" last="Chao">Wen-Cheng Chao</name>
<affiliation wicri:level="1"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0573 0731</institution-id>
<institution-id institution-id-type="GRID">grid.410764.0</institution-id>
<institution>Department of the Medical Research,</institution>
<institution>Taichung Veterans General Hospital,</institution>
</institution-wrap>
Taichung, Taiwan</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Taichung</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff7"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0532 1428</institution-id>
<institution-id institution-id-type="GRID">grid.265231.1</institution-id>
<institution>Department of Industrial Engineering and Enterprise Information,</institution>
<institution>Tung Hai University,</institution>
</institution-wrap>
Taichung, Taiwan</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Taichung</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff12"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0573 0731</institution-id>
<institution-id institution-id-type="GRID">grid.410764.0</institution-id>
<institution>Department of Critical Care Medicine,</institution>
<institution>Taichung Veterans General Hospital,</institution>
</institution-wrap>
Taichung, Taiwan</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Taichung</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff14"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9193 1222</institution-id>
<institution-id institution-id-type="GRID">grid.412038.c</institution-id>
<institution>Department of Business Administration,</institution>
<institution>National Changhua University of Education,</institution>
</institution-wrap>
Changhua, Taiwan</nlm:aff>
<country xml:lang="fr">Taïwan</country>
<wicri:regionArea>Changhua</wicri:regionArea>
</affiliation>
</author>
</analytic>
<series><title level="j">BMC Infectious Diseases</title>
<idno type="eISSN">1471-2334</idno>
<imprint><date when="2020">2020</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p id="Par1">Pneumocystis pneumonia (PCP) is increasingly being diagnosed in patients with systemic lupus erythematosus (SLE), and hydroxychloroquine (HCQ) has been found to possess antifungal activities. We hence aimed to investigate the association between HCQ and PCP risk among patients with SLE.</p>
</sec>
<sec><title>Methods</title>
<p id="Par2">Using the 1997–2013 nationwide claim data, we identified 24,343 newly-diagnosed SLE patients. We then identified 58 PCP cases and selected 348 non-PCP controls matching (1:6) by age, sex, disease duration and the year of PCP diagnosis date. The risk of PCP was assessed by determing odds ratios (ORs) with 95% confidence intervals (CIs) by using multivariable conditional logistic regression.</p>
</sec>
<sec><title>Results</title>
<p id="Par3">The risk of PCP was associated with moderate to severe renal disease (OR 6.73, 95% CI 1.98–22.92), higher doses of glucocorticoids (≤5 mg/day, reference; 5–10 mg/day, OR 25.88, 95% CI 2.97–225.33; > 10 mg/day, OR 286.58, 95% CI 28.58–> 999), higher 3-month cumulative dose of cyclophosphamide (not use, reference; ≤1.4 g, OR 0.64, 95% CI 0.14–3.01; > 1.4 g, OR 11.52, 95% CI 1.97–67.39) and use of mycophenolate mofetil/mycophenolic acid (OR 50.79, 95% CI 5.32–484.77), whereas 3-month cumulative dose of HCQ was associated with a reduced risk of PCP among patients with SLE (not use, reference; ≤14 g, OR 0.69, 95% CI 0.21–2.24; > 14 g, OR 0.20, 95% CI 0.05–0.71).</p>
</sec>
<sec><title>Conclusions</title>
<p id="Par4">This study demonstrated incident PCP was associated with mycophenolate mofetil/mycophenolic acid use and higher doses of cyclophosphamide or glucocorticoid, whereas the use of a higher dose of HCQ was associated with a reduced risk of PCP in lupus patients.</p>
</sec>
</div>
</front>
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</author>
<author><name sortKey="Lee, H" uniqKey="Lee H">H Lee</name>
</author>
<author><name sortKey="Song, Yw" uniqKey="Song Y">YW Song</name>
</author>
<author><name sortKey="Lee, Eb" uniqKey="Lee E">EB Lee</name>
</author>
</analytic>
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<biblStruct><analytic><author><name sortKey="Cheng, Tm" uniqKey="Cheng T">TM Cheng</name>
</author>
</analytic>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Infect Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">BMC Infect. Dis</journal-id>
<journal-title-group><journal-title>BMC Infectious Diseases</journal-title>
</journal-title-group>
<issn pub-type="epub">1471-2334</issn>
<publisher><publisher-name>BioMed Central</publisher-name>
<publisher-loc>London</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">32041539</article-id>
<article-id pub-id-type="pmc">7011312</article-id>
<article-id pub-id-type="publisher-id">4826</article-id>
<article-id pub-id-type="doi">10.1186/s12879-020-4826-1</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Hydroxychloroquine may reduce risk of Pneumocystis pneumonia in lupus patients: a Nationwide, population-based case-control study</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" equal-contrib="yes"><name><surname>Yeo</surname>
<given-names>Kai-Jieh</given-names>
</name>
<xref ref-type="aff" rid="Aff1">1</xref>
</contrib>
<contrib contrib-type="author" equal-contrib="yes"><name><surname>Chen</surname>
<given-names>Hsin-Hua</given-names>
</name>
<xref ref-type="aff" rid="Aff2">2</xref>
<xref ref-type="aff" rid="Aff3">3</xref>
<xref ref-type="aff" rid="Aff4">4</xref>
<xref ref-type="aff" rid="Aff5">5</xref>
<xref ref-type="aff" rid="Aff6">6</xref>
<xref ref-type="aff" rid="Aff7">7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chen</surname>
<given-names>Yi-Ming</given-names>
</name>
<xref ref-type="aff" rid="Aff2">2</xref>
<xref ref-type="aff" rid="Aff3">3</xref>
<xref ref-type="aff" rid="Aff4">4</xref>
<xref ref-type="aff" rid="Aff5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lin</surname>
<given-names>Ching-Heng</given-names>
</name>
<xref ref-type="aff" rid="Aff2">2</xref>
<xref ref-type="aff" rid="Aff8">8</xref>
<xref ref-type="aff" rid="Aff9">9</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chen</surname>
<given-names>Der-Yuan</given-names>
</name>
<xref ref-type="aff" rid="Aff1">1</xref>
<xref ref-type="aff" rid="Aff10">10</xref>
<xref ref-type="aff" rid="Aff11">11</xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Lai</surname>
<given-names>Chih-Ming</given-names>
</name>
<address><email>cmlai@vghtc.gov.tw</email>
</address>
<xref ref-type="aff" rid="Aff12">12</xref>
<xref ref-type="aff" rid="Aff13">13</xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0001-9631-8934</contrib-id>
<name><surname>Chao</surname>
<given-names>Wen-Cheng</given-names>
</name>
<address><email>cwc081@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff2">2</xref>
<xref ref-type="aff" rid="Aff7">7</xref>
<xref ref-type="aff" rid="Aff12">12</xref>
<xref ref-type="aff" rid="Aff14">14</xref>
</contrib>
<aff id="Aff1"><label>1</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0572 9415</institution-id>
<institution-id institution-id-type="GRID">grid.411508.9</institution-id>
<institution>Rheumatology and Immunology Center,</institution>
<institution>China Medical University Hospital,</institution>
</institution-wrap>
Taichung, Taiwan</aff>
<aff id="Aff2"><label>2</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0573 0731</institution-id>
<institution-id institution-id-type="GRID">grid.410764.0</institution-id>
<institution>Department of the Medical Research,</institution>
<institution>Taichung Veterans General Hospital,</institution>
</institution-wrap>
Taichung, Taiwan</aff>
<aff id="Aff3"><label>3</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0573 0731</institution-id>
<institution-id institution-id-type="GRID">grid.410764.0</institution-id>
<institution>Department of Internal Medicine,</institution>
<institution>Taichung Veterans General Hospital,</institution>
</institution-wrap>
Taichung, Taiwan</aff>
<aff id="Aff4"><label>4</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0532 3749</institution-id>
<institution-id institution-id-type="GRID">grid.260542.7</institution-id>
<institution>Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine,</institution>
<institution>Chung Hsing University,</institution>
</institution-wrap>
Taichung, Taiwan</aff>
<aff id="Aff5"><label>5</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0425 5914</institution-id>
<institution-id institution-id-type="GRID">grid.260770.4</institution-id>
<institution>School of Medicine, National Yang-Ming University,</institution>
</institution-wrap>
Taipei, Taiwan</aff>
<aff id="Aff6"><label>6</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0425 5914</institution-id>
<institution-id institution-id-type="GRID">grid.260770.4</institution-id>
<institution>Institute of Public Health and Community Medicine Research Center,</institution>
<institution>National Yang-Ming University,</institution>
</institution-wrap>
Taipei, Taiwan</aff>
<aff id="Aff7"><label>7</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0532 1428</institution-id>
<institution-id institution-id-type="GRID">grid.265231.1</institution-id>
<institution>Department of Industrial Engineering and Enterprise Information,</institution>
<institution>Tung Hai University,</institution>
</institution-wrap>
Taichung, Taiwan</aff>
<aff id="Aff8"><label>8</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0573 0416</institution-id>
<institution-id institution-id-type="GRID">grid.412146.4</institution-id>
<institution>Department of Healthcare Management,</institution>
<institution>National Taipei University of Nursing and Health Sciences,</institution>
</institution-wrap>
Taipei, Taiwan</aff>
<aff id="Aff9"><label>9</label>
Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan</aff>
<aff id="Aff10"><label>10</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0572 9415</institution-id>
<institution-id institution-id-type="GRID">grid.411508.9</institution-id>
<institution>Translational Medicine Laboratory, Rheumatic Diseases Research Center,</institution>
<institution>China Medical University Hospital,</institution>
</institution-wrap>
Taichung, Taiwan</aff>
<aff id="Aff11"><label>11</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0083 6092</institution-id>
<institution-id institution-id-type="GRID">grid.254145.3</institution-id>
<institution>School of Medicine,</institution>
<institution>China Medical University,</institution>
</institution-wrap>
Taichung, Taiwan</aff>
<aff id="Aff12"><label>12</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0573 0731</institution-id>
<institution-id institution-id-type="GRID">grid.410764.0</institution-id>
<institution>Department of Critical Care Medicine,</institution>
<institution>Taichung Veterans General Hospital,</institution>
</institution-wrap>
Taichung, Taiwan</aff>
<aff id="Aff13"><label>13</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0573 0731</institution-id>
<institution-id institution-id-type="GRID">grid.410764.0</institution-id>
<institution>Department of Neurosurgery,</institution>
<institution>Neurological Institute, Taichung Veterans General Hospital,</institution>
</institution-wrap>
Taichung, Taiwan</aff>
<aff id="Aff14"><label>14</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9193 1222</institution-id>
<institution-id institution-id-type="GRID">grid.412038.c</institution-id>
<institution>Department of Business Administration,</institution>
<institution>National Changhua University of Education,</institution>
</institution-wrap>
Changhua, Taiwan</aff>
</contrib-group>
<pub-date pub-type="epub"><day>10</day>
<month>2</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>10</day>
<month>2</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="collection"><year>2020</year>
</pub-date>
<volume>20</volume>
<elocation-id>112</elocation-id>
<history><date date-type="received"><day>16</day>
<month>11</month>
<year>2019</year>
</date>
<date date-type="accepted"><day>24</day>
<month>1</month>
<year>2020</year>
</date>
</history>
<permissions><copyright-statement>© The Author(s). 2020</copyright-statement>
<license license-type="OpenAccess"><license-p><bold>Open Access</bold>
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>
) applies to the data made available in this article, unless otherwise stated.</license-p>
</license>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p id="Par1">Pneumocystis pneumonia (PCP) is increasingly being diagnosed in patients with systemic lupus erythematosus (SLE), and hydroxychloroquine (HCQ) has been found to possess antifungal activities. We hence aimed to investigate the association between HCQ and PCP risk among patients with SLE.</p>
</sec>
<sec><title>Methods</title>
<p id="Par2">Using the 1997–2013 nationwide claim data, we identified 24,343 newly-diagnosed SLE patients. We then identified 58 PCP cases and selected 348 non-PCP controls matching (1:6) by age, sex, disease duration and the year of PCP diagnosis date. The risk of PCP was assessed by determing odds ratios (ORs) with 95% confidence intervals (CIs) by using multivariable conditional logistic regression.</p>
</sec>
<sec><title>Results</title>
<p id="Par3">The risk of PCP was associated with moderate to severe renal disease (OR 6.73, 95% CI 1.98–22.92), higher doses of glucocorticoids (≤5 mg/day, reference; 5–10 mg/day, OR 25.88, 95% CI 2.97–225.33; > 10 mg/day, OR 286.58, 95% CI 28.58–> 999), higher 3-month cumulative dose of cyclophosphamide (not use, reference; ≤1.4 g, OR 0.64, 95% CI 0.14–3.01; > 1.4 g, OR 11.52, 95% CI 1.97–67.39) and use of mycophenolate mofetil/mycophenolic acid (OR 50.79, 95% CI 5.32–484.77), whereas 3-month cumulative dose of HCQ was associated with a reduced risk of PCP among patients with SLE (not use, reference; ≤14 g, OR 0.69, 95% CI 0.21–2.24; > 14 g, OR 0.20, 95% CI 0.05–0.71).</p>
</sec>
<sec><title>Conclusions</title>
<p id="Par4">This study demonstrated incident PCP was associated with mycophenolate mofetil/mycophenolic acid use and higher doses of cyclophosphamide or glucocorticoid, whereas the use of a higher dose of HCQ was associated with a reduced risk of PCP in lupus patients.</p>
</sec>
</abstract>
<kwd-group xml:lang="en"><title>Keywords</title>
<kwd>Lupus</kwd>
<kwd>Pneumocystis pneumonia</kwd>
<kwd>Hydroxychloroquine</kwd>
<kwd>Glucocorticoid</kwd>
<kwd>Mycophenolate mofetil</kwd>
</kwd-group>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2020</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
</record>
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