The risk of nontuberculous mycobacterial infection in patients with Sjögren's syndrome: a nationwide, population-based cohort study

Abstract

Background: Nontuberculous mycobacterial (NTM) infection in immunocompromized patients is currently a growing health concern, and we aimed to examine the relative risk of NTM infection in patients with Sjögren's syndrome (SS) compared with that in non-SS individuals.

Methods: We used the 2003-2012 Taiwanese National Health Insurance Research Database to identify 6554 incident SS cases during 2007-2012 and selected 98,310 non-SS controls matched (1:15) for age, gender, and the year of first SS diagnosis date after excluding those who had rheumatoid arthritis or systemic lupus erythematosus.

Results: We identified four NTM-infected patients in the SS group (three in the first year) and nine in the non-SS group (three in the first year). SS patients had a higher incidence rate of NTM infection than that in non-SS individuals (IRR, 7.56; 95% CI, 2.33-24.55), especially during the first year (IRR, 16.05; 95% CI, 3.24-79.51). After adjusting for potential confounders, the risk of NTM infection was not increased in SS patients during the entire follow-up period or during the first year, but the risk increased in SS patients treated with immunosuppressants during the entire follow-up period (HR, 17.77; 95% CI, 4.53-69.61), especially during the first year (HR, 33.33; 95% CI, 4.37-254.23).

Conclusion: An increased risk of NTM infection was found in SS patients treated with immunosuppressants during the first year after SS diagnosis.

Keywords: Immunosuppressant; Nontuberculous mycobacteria; Sjögren’s syndrome.

Fig. 1

Kaplan-Meier survival curve for incidental NTM infection. a Categorized by SS and non-SS. b Categorized by non-SS, SS treated without immunosuppressants, and SS treated with immunosuppressants. NTM, nontuberculous mycobacteria; SS: Sjögren’s syndrome