Hydroxychloroquine may reduce risk of Pneumocystis pneumonia in lupus patients: a Nationwide, population-based case-control study
Identifieur interne : 000138 ( an2020/Analysis ); précédent : 000137; suivant : 000139Hydroxychloroquine 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
Affiliations:
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id="Aff9">Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City</wicri:regionArea><wicri:noRegion>New Taipei City</wicri:noRegion></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><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Fillatre, P" uniqKey="Fillatre P">P Fillatre</name></author><author><name sortKey="Decaux, O" uniqKey="Decaux O">O Decaux</name></author><author><name sortKey="Jouneau, S" uniqKey="Jouneau S">S Jouneau</name></author><author><name sortKey="Revest, M" uniqKey="Revest M">M Revest</name></author><author><name sortKey="Gacouin, A" uniqKey="Gacouin A">A Gacouin</name></author><author><name sortKey="Robert Gangneux, F" uniqKey="Robert Gangneux F">F Robert-Gangneux</name></author><author><name sortKey="Fresnel, A" uniqKey="Fresnel A">A Fresnel</name></author><author><name sortKey="Guiguen, C" uniqKey="Guiguen C">C Guiguen</name></author><author><name sortKey="Le Tulzo, Y" uniqKey="Le Tulzo Y">Y Le 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Cheng</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Taïwan</li></country></list><tree><country name="Taïwan"><noRegion><name sortKey="Yeo, Kai Jieh" sort="Yeo, Kai Jieh" uniqKey="Yeo K" first="Kai-Jieh" last="Yeo">Kai-Jieh Yeo</name></noRegion><name sortKey="Chao, Wen Cheng" sort="Chao, Wen Cheng" uniqKey="Chao W" first="Wen-Cheng" last="Chao">Wen-Cheng Chao</name><name sortKey="Chao, Wen Cheng" sort="Chao, Wen Cheng" uniqKey="Chao W" first="Wen-Cheng" last="Chao">Wen-Cheng Chao</name><name sortKey="Chao, Wen Cheng" sort="Chao, Wen Cheng" uniqKey="Chao W" first="Wen-Cheng" last="Chao">Wen-Cheng Chao</name><name sortKey="Chao, Wen Cheng" sort="Chao, Wen Cheng" uniqKey="Chao W" first="Wen-Cheng" last="Chao">Wen-Cheng Chao</name><name sortKey="Chen, Der Yuan" sort="Chen, Der Yuan" uniqKey="Chen D" first="Der-Yuan" last="Chen">Der-Yuan Chen</name><name sortKey="Chen, Der Yuan" sort="Chen, Der Yuan" uniqKey="Chen D" first="Der-Yuan" last="Chen">Der-Yuan Chen</name><name sortKey="Chen, Der Yuan" sort="Chen, Der Yuan" uniqKey="Chen D" first="Der-Yuan" last="Chen">Der-Yuan Chen</name><name sortKey="Chen, Hsin Hua" sort="Chen, Hsin Hua" uniqKey="Chen H" first="Hsin-Hua" last="Chen">Hsin-Hua Chen</name><name sortKey="Chen, Hsin Hua" sort="Chen, Hsin Hua" uniqKey="Chen H" first="Hsin-Hua" last="Chen">Hsin-Hua Chen</name><name sortKey="Chen, Hsin Hua" sort="Chen, Hsin Hua" uniqKey="Chen H" first="Hsin-Hua" last="Chen">Hsin-Hua Chen</name><name sortKey="Chen, Hsin Hua" sort="Chen, Hsin Hua" uniqKey="Chen H" first="Hsin-Hua" last="Chen">Hsin-Hua Chen</name><name sortKey="Chen, Hsin Hua" sort="Chen, Hsin Hua" uniqKey="Chen H" first="Hsin-Hua" last="Chen">Hsin-Hua Chen</name><name sortKey="Chen, Hsin Hua" sort="Chen, Hsin Hua" uniqKey="Chen H" first="Hsin-Hua" last="Chen">Hsin-Hua Chen</name><name sortKey="Chen, Yi Ming" sort="Chen, Yi Ming" uniqKey="Chen Y" first="Yi-Ming" last="Chen">Yi-Ming Chen</name><name sortKey="Chen, Yi Ming" sort="Chen, Yi Ming" uniqKey="Chen Y" first="Yi-Ming" last="Chen">Yi-Ming Chen</name><name sortKey="Chen, Yi Ming" sort="Chen, Yi Ming" uniqKey="Chen Y" first="Yi-Ming" last="Chen">Yi-Ming Chen</name><name sortKey="Chen, Yi Ming" sort="Chen, Yi Ming" uniqKey="Chen Y" first="Yi-Ming" last="Chen">Yi-Ming Chen</name><name sortKey="Lai, Chih Ming" sort="Lai, Chih Ming" uniqKey="Lai C" first="Chih-Ming" last="Lai">Chih-Ming Lai</name><name sortKey="Lai, Chih Ming" sort="Lai, Chih Ming" uniqKey="Lai C" first="Chih-Ming" last="Lai">Chih-Ming Lai</name><name sortKey="Lin, Ching Heng" sort="Lin, Ching Heng" uniqKey="Lin C" first="Ching-Heng" last="Lin">Ching-Heng Lin</name><name sortKey="Lin, Ching Heng" sort="Lin, Ching Heng" uniqKey="Lin C" first="Ching-Heng" last="Lin">Ching-Heng Lin</name><name sortKey="Lin, Ching Heng" sort="Lin, Ching Heng" uniqKey="Lin C" first="Ching-Heng" last="Lin">Ching-Heng Lin</name></country></tree></affiliations></record>Pour manipuler ce document sous 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