GrippeFranceV1, Main, Exploration, bibRecord, 000121

Infections in non-splenectomized persistent or chronic primary immune thrombocytopenia adults: risk factors and vaccination effect.

Identifieur interne : 000121 ( Main/Exploration ); précédent : 000120; suivant : 000122

Infections in non-splenectomized persistent or chronic primary immune thrombocytopenia adults: risk factors and vaccination effect.

Auteurs : G. Moulis [France] ; M. Lapeyre-Mestre [France] ; A. Palmaro [France] ; L. Sailler [France]

Source :

Journal of thrombosis and haemostasis : JTH [ 1538-7836 ] ; 2017.

RBID : pubmed:28078756

Descripteurs français

English descriptors

KwdEn :
- Adrenal Cortex Hormones (adverse effects), Adrenal Cortex Hormones (therapeutic use), Adult (MeSH), Aged (MeSH), Cohort Studies (MeSH), Female (MeSH), France (MeSH), Humans (MeSH), Influenza Vaccines (therapeutic use), Lung Diseases (complications), Male (MeSH), Middle Aged (MeSH), Multivariate Analysis (MeSH), Pneumococcal Vaccines (therapeutic use), Proportional Hazards Models (MeSH), Purpura, Thrombocytopenic, Idiopathic (complications), Risk Factors (MeSH), Rituximab (adverse effects), Rituximab (therapeutic use), Spleen (MeSH), Splenectomy (MeSH), Treatment Outcome (MeSH).
MESH :
- chemical , adverse effects : Adrenal Cortex Hormones, Rituximab.
- chemical , therapeutic use : Adrenal Cortex Hormones, Influenza Vaccines, Pneumococcal Vaccines, Rituximab.
- complications : Lung Diseases, Purpura, Thrombocytopenic, Idiopathic.
- Adult, Aged, Cohort Studies, Female, France, Humans, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Risk Factors, Spleen, Splenectomy, Treatment Outcome.

Abstract

Essentials The risk factors for infection in immune thrombocytopenia are not well known. We conducted a national pharmacoepidemiological study. Pulmonary disease, corticosteroids and rituximab were the main risk factors for infections. Pneumococcal and influenza vaccines were protective against infections.

SUMMARY

Introduction Risk factors for infection and protective effect of vaccines in immune thrombocytopenia (ITP) patients in the era of rituximab therapy are unknown. Objectives To assess the risk factors for serious and non-serious infections (respectively, SIs and NSIs) in non-splenectomized adults treated for persistent or chronic primary ITP, including the effect of pneumococcal and influenza vaccines. Patients/Methods The population was the 2009-2012 FAITH cohort (n = 1805), which is the cohort of all incident (newly diagnosed) primary ITP adults treated > 3 months in France built into the national health insurance database (SNIIRAM). SIs were hospitalizations with any infection as the primary diagnosis code. NSIs were identified using out-of-hospital antibiotic dispensing. Cox models were performed. Results Incidence rates were 6.3/100 patient-years (95% confidence interval [CI], 5.4-7.4) for SIs (lower respiratory tract in 42.8% of the cases) and 100.5/100 patient-years (95% CI, 95.0-106.3) for NSIs. In multivariate analyses, increasing age and chronic pulmonary disease were associated with both SI and NSI occurrence. The hazard ratios (HRs) for corticosteroids and rituximab were, respectively, 3.83 (95% CI, 2.76-5.31) and 2.60 (95% CI, 1.67-4.03) for SIs and 2.46 (95% CI, 2.19-2.76) and 1.49 (95% CI, 1.28-1.74) for NSIs. Pneumococcal vaccine showed a protective effect for both SIs and NSIs (0.38 [95% CI, 0.20-0.73] and 0.52 [95% CI, 0.43-0.65], respectively), as did influenza vaccine (0.42 [95% CI, 0.27-0.64] and 0.49 [95% CI, 0.41-0.59], respectively). Conclusions Chronic pulmonary disease, corticosteroids and rituximab are the main risk factors for infections, whereas pneumococcal and influenza vaccines are protective against SIs and NSIs.

DOI: 10.1111/jth.13622
PubMed: 28078756

Affiliations:

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Le document en format XML

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<term>Adrenal Cortex Hormones (therapeutic use)</term>
<term>Adult (MeSH)</term>
<term>Aged (MeSH)</term>
<term>Cohort Studies (MeSH)</term>
<term>Female (MeSH)</term>
<term>France (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Influenza Vaccines (therapeutic use)</term>
<term>Lung Diseases (complications)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Multivariate Analysis (MeSH)</term>
<term>Pneumococcal Vaccines (therapeutic use)</term>
<term>Proportional Hazards Models (MeSH)</term>
<term>Purpura, Thrombocytopenic, Idiopathic (complications)</term>
<term>Risk Factors (MeSH)</term>
<term>Rituximab (adverse effects)</term>
<term>Rituximab (therapeutic use)</term>
<term>Spleen (MeSH)</term>
<term>Splenectomy (MeSH)</term>
<term>Treatment Outcome (MeSH)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term>
<term>Adulte d'âge moyen (MeSH)</term>
<term>Analyse multifactorielle (MeSH)</term>
<term>Facteurs de risque (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>France (MeSH)</term>
<term>Hormones corticosurrénaliennes (effets indésirables)</term>
<term>Hormones corticosurrénaliennes (usage thérapeutique)</term>
<term>Humains (MeSH)</term>
<term>Maladies pulmonaires (complications)</term>
<term>Modèles des risques proportionnels (MeSH)</term>
<term>Mâle (MeSH)</term>
<term>Purpura thrombopénique idiopathique (complications)</term>
<term>Rate (MeSH)</term>
<term>Rituximab (effets indésirables)</term>
<term>Rituximab (usage thérapeutique)</term>
<term>Résultat thérapeutique (MeSH)</term>
<term>Splénectomie (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
<term>Vaccins antigrippaux (usage thérapeutique)</term>
<term>Vaccins antipneumococciques (usage thérapeutique)</term>
<term>Études de cohortes (MeSH)</term>
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<keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Adrenal Cortex Hormones</term>
<term>Rituximab</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Adrenal Cortex Hormones</term>
<term>Influenza Vaccines</term>
<term>Pneumococcal Vaccines</term>
<term>Rituximab</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Lung Diseases</term>
<term>Purpura, Thrombocytopenic, Idiopathic</term>
</keywords>
<keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Hormones corticosurrénaliennes</term>
<term>Maladies pulmonaires</term>
<term>Purpura thrombopénique idiopathique</term>
<term>Rituximab</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Hormones corticosurrénaliennes</term>
<term>Rituximab</term>
<term>Vaccins antigrippaux</term>
<term>Vaccins antipneumococciques</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Cohort Studies</term>
<term>Female</term>
<term>France</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Multivariate Analysis</term>
<term>Proportional Hazards Models</term>
<term>Risk Factors</term>
<term>Spleen</term>
<term>Splenectomy</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Analyse multifactorielle</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>France</term>
<term>Humains</term>
<term>Modèles des risques proportionnels</term>
<term>Mâle</term>
<term>Rate</term>
<term>Résultat thérapeutique</term>
<term>Splénectomie</term>
<term>Sujet âgé</term>
<term>Études de cohortes</term>
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<front><div type="abstract" xml:lang="en">Essentials The risk factors for infection in immune thrombocytopenia are not well known. We conducted a national pharmacoepidemiological study. Pulmonary disease, corticosteroids and rituximab were the main risk factors for infections. Pneumococcal and influenza vaccines were protective against infections.</div>
<div type="abstract" xml:lang="en"><p><b>SUMMARY</b>
</p>
<p>Introduction Risk factors for infection and protective effect of vaccines in immune thrombocytopenia (ITP) patients in the era of rituximab therapy are unknown. Objectives To assess the risk factors for serious and non-serious infections (respectively, SIs and NSIs) in non-splenectomized adults treated for persistent or chronic primary ITP, including the effect of pneumococcal and influenza vaccines. Patients/Methods The population was the 2009-2012 FAITH cohort (n = 1805), which is the cohort of all incident (newly diagnosed) primary ITP adults treated > 3 months in France built into the national health insurance database (SNIIRAM). SIs were hospitalizations with any infection as the primary diagnosis code. NSIs were identified using out-of-hospital antibiotic dispensing. Cox models were performed. Results Incidence rates were 6.3/100 patient-years (95% confidence interval [CI], 5.4-7.4) for SIs (lower respiratory tract in 42.8% of the cases) and 100.5/100 patient-years (95% CI, 95.0-106.3) for NSIs. In multivariate analyses, increasing age and chronic pulmonary disease were associated with both SI and NSI occurrence. The hazard ratios (HRs) for corticosteroids and rituximab were, respectively, 3.83 (95% CI, 2.76-5.31) and 2.60 (95% CI, 1.67-4.03) for SIs and 2.46 (95% CI, 2.19-2.76) and 1.49 (95% CI, 1.28-1.74) for NSIs. Pneumococcal vaccine showed a protective effect for both SIs and NSIs (0.38 [95% CI, 0.20-0.73] and 0.52 [95% CI, 0.43-0.65], respectively), as did influenza vaccine (0.42 [95% CI, 0.27-0.64] and 0.49 [95% CI, 0.41-0.59], respectively). Conclusions Chronic pulmonary disease, corticosteroids and rituximab are the main risk factors for infections, whereas pneumococcal and influenza vaccines are protective against SIs and NSIs.</p>
</div>
</front>
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</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1538-7836</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>15</Volume>
<Issue>4</Issue>
<PubDate><Year>2017</Year>
<Month>04</Month>
</PubDate>
</JournalIssue>
<Title>Journal of thrombosis and haemostasis : JTH</Title>
<ISOAbbreviation>J. Thromb. Haemost.</ISOAbbreviation>
</Journal>
<ArticleTitle>Infections in non-splenectomized persistent or chronic primary immune thrombocytopenia adults: risk factors and vaccination effect.</ArticleTitle>
<Pagination><MedlinePgn>785-791</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1111/jth.13622</ELocationID>
<Abstract><AbstractText>Essentials The risk factors for infection in immune thrombocytopenia are not well known. We conducted a national pharmacoepidemiological study. Pulmonary disease, corticosteroids and rituximab were the main risk factors for infections. Pneumococcal and influenza vaccines were protective against infections.</AbstractText>
<AbstractText Label="SUMMARY">Introduction Risk factors for infection and protective effect of vaccines in immune thrombocytopenia (ITP) patients in the era of rituximab therapy are unknown. Objectives To assess the risk factors for serious and non-serious infections (respectively, SIs and NSIs) in non-splenectomized adults treated for persistent or chronic primary ITP, including the effect of pneumococcal and influenza vaccines. Patients/Methods The population was the 2009-2012 FAITH cohort (n = 1805), which is the cohort of all incident (newly diagnosed) primary ITP adults treated > 3 months in France built into the national health insurance database (SNIIRAM). SIs were hospitalizations with any infection as the primary diagnosis code. NSIs were identified using out-of-hospital antibiotic dispensing. Cox models were performed. Results Incidence rates were 6.3/100 patient-years (95% confidence interval [CI], 5.4-7.4) for SIs (lower respiratory tract in 42.8% of the cases) and 100.5/100 patient-years (95% CI, 95.0-106.3) for NSIs. In multivariate analyses, increasing age and chronic pulmonary disease were associated with both SI and NSI occurrence. The hazard ratios (HRs) for corticosteroids and rituximab were, respectively, 3.83 (95% CI, 2.76-5.31) and 2.60 (95% CI, 1.67-4.03) for SIs and 2.46 (95% CI, 2.19-2.76) and 1.49 (95% CI, 1.28-1.74) for NSIs. Pneumococcal vaccine showed a protective effect for both SIs and NSIs (0.38 [95% CI, 0.20-0.73] and 0.52 [95% CI, 0.43-0.65], respectively), as did influenza vaccine (0.42 [95% CI, 0.27-0.64] and 0.49 [95% CI, 0.41-0.59], respectively). Conclusions Chronic pulmonary disease, corticosteroids and rituximab are the main risk factors for infections, whereas pneumococcal and influenza vaccines are protective against SIs and NSIs.</AbstractText>
<CopyrightInformation>© 2017 International Society on Thrombosis and Haemostasis.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Moulis</LastName>
<ForeName>G</ForeName>
<Initials>G</Initials>
<Identifier Source="ORCID">0000-0001-9953-4640</Identifier>
<AffiliationInfo><Affiliation>UMR 1027, INSERM, Université de Toulouse III, Toulouse, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Centre d'Investigation Clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Lapeyre-Mestre</LastName>
<ForeName>M</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>UMR 1027, INSERM, Université de Toulouse III, Toulouse, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Centre d'Investigation Clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Palmaro</LastName>
<ForeName>A</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>UMR 1027, INSERM, Université de Toulouse III, Toulouse, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Centre d'Investigation Clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Sailler</LastName>
<ForeName>L</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>UMR 1027, INSERM, Université de Toulouse III, Toulouse, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Centre d'Investigation Clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
<PublicationType UI="D064888">Observational Study</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic"><Year>2017</Year>
<Month>02</Month>
<Day>25</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo><Country>England</Country>
<MedlineTA>J Thromb Haemost</MedlineTA>
<NlmUniqueID>101170508</NlmUniqueID>
<ISSNLinking>1538-7836</ISSNLinking>
</MedlineJournalInfo>
<ChemicalList><Chemical><RegistryNumber>0</RegistryNumber>
<NameOfSubstance UI="D000305">Adrenal Cortex Hormones</NameOfSubstance>
</Chemical>
<Chemical><RegistryNumber>0</RegistryNumber>
<NameOfSubstance UI="D007252">Influenza Vaccines</NameOfSubstance>
</Chemical>
<Chemical><RegistryNumber>0</RegistryNumber>
<NameOfSubstance UI="D022242">Pneumococcal Vaccines</NameOfSubstance>
</Chemical>
<Chemical><RegistryNumber>4F4X42SYQ6</RegistryNumber>
<NameOfSubstance UI="D000069283">Rituximab</NameOfSubstance>
</Chemical>
</ChemicalList>
<CitationSubset>IM</CitationSubset>
<MeshHeadingList><MeshHeading><DescriptorName UI="D000305" MajorTopicYN="N">Adrenal Cortex Hormones</DescriptorName>
<QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName>
<QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D015331" MajorTopicYN="N">Cohort Studies</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D005602" MajorTopicYN="N">France</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D007252" MajorTopicYN="N">Influenza Vaccines</DescriptorName>
<QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008171" MajorTopicYN="N">Lung Diseases</DescriptorName>
<QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D015999" MajorTopicYN="N">Multivariate Analysis</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D022242" MajorTopicYN="N">Pneumococcal Vaccines</DescriptorName>
<QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D016016" MajorTopicYN="N">Proportional Hazards Models</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D016553" MajorTopicYN="N">Purpura, Thrombocytopenic, Idiopathic</DescriptorName>
<QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000069283" MajorTopicYN="N">Rituximab</DescriptorName>
<QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName>
<QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D013154" MajorTopicYN="N">Spleen</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D013156" MajorTopicYN="N">Splenectomy</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName>
</MeshHeading>
</MeshHeadingList>
<KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">glucocorticoids</Keyword>
<Keyword MajorTopicYN="Y">immune thrombocytopenia</Keyword>
<Keyword MajorTopicYN="Y">infection</Keyword>
<Keyword MajorTopicYN="Y">rituximab</Keyword>
<Keyword MajorTopicYN="Y">vaccine</Keyword>
</KeywordList>
</MedlineCitation>
<PubmedData><History><PubMedPubDate PubStatus="received"><Year>2016</Year>
<Month>06</Month>
<Day>26</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="pubmed"><Year>2017</Year>
<Month>1</Month>
<Day>13</Day>
<Hour>6</Hour>
<Minute>0</Minute>
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<PubMedPubDate PubStatus="medline"><Year>2018</Year>
<Month>2</Month>
<Day>2</Day>
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<PubMedPubDate PubStatus="entrez"><Year>2017</Year>
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</History>
<PublicationStatus>ppublish</PublicationStatus>
<ArticleIdList><ArticleId IdType="pubmed">28078756</ArticleId>
<ArticleId IdType="doi">10.1111/jth.13622</ArticleId>
</ArticleIdList>
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<affiliations><list><country><li>France</li>
</country>
<region><li>Midi-Pyrénées</li>
<li>Occitanie (région administrative)</li>
</region>
<settlement><li>Toulouse</li>
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<tree><country name="France"><region name="Occitanie (région administrative)"><name sortKey="Moulis, G" sort="Moulis, G" uniqKey="Moulis G" first="G" last="Moulis">G. Moulis</name>
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<name sortKey="Lapeyre Mestre, M" sort="Lapeyre Mestre, M" uniqKey="Lapeyre Mestre M" first="M" last="Lapeyre-Mestre">M. Lapeyre-Mestre</name>
<name sortKey="Lapeyre Mestre, M" sort="Lapeyre Mestre, M" uniqKey="Lapeyre Mestre M" first="M" last="Lapeyre-Mestre">M. Lapeyre-Mestre</name>
<name sortKey="Lapeyre Mestre, M" sort="Lapeyre Mestre, M" uniqKey="Lapeyre Mestre M" first="M" last="Lapeyre-Mestre">M. Lapeyre-Mestre</name>
<name sortKey="Moulis, G" sort="Moulis, G" uniqKey="Moulis G" first="G" last="Moulis">G. Moulis</name>
<name sortKey="Moulis, G" sort="Moulis, G" uniqKey="Moulis G" first="G" last="Moulis">G. Moulis</name>
<name sortKey="Palmaro, A" sort="Palmaro, A" uniqKey="Palmaro A" first="A" last="Palmaro">A. Palmaro</name>
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Infections in non-splenectomized persistent or chronic primary immune thrombocytopenia adults: risk factors and vaccination effect.

Infections in non-splenectomized persistent or chronic primary immune thrombocytopenia adults: risk factors and vaccination effect.

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