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. 2022 Nov;9(1):e000779.
doi: 10.1136/lupus-2022-000779.

Comparison of short interval and low dose (SILD) with high dose of cyclophosphamide in the susceptibility to infection in SLE: a multicentrereal-world study

Miao Shao  1 , Miao Miao  1 , Xia Zhang  1 , Xiaoying Zhang  1   2 , Yuan An  1 , Huifang Guo  3 , Lingyan Lei  3 , Qing Zhao  4 , Yanjie Ding  4 , Jin Lin  5 , Rui Wu  6 , Feng Yu  7 , Yucui Li  8 , Huali Miao  8 , Liyun Zhang  8 , Yan Du  9 , Ruiying Jiao  10 , Lixia Pang  10 , Li Long  11 , Xueming Yao  12 , Xiaofei Shi  13 , Fei Wang  13 , Luping Cui  14 , Lei Zhang  15 , Shengyun Liu  15 , Fuai Lu  16 , Kangkai Luo  16 , Simeng Zhao  16 , Yongfu Wang  16 , Xiao Wu  17 , Qingwen Wang  17 , Hongjiang Liu  18 , Shulin Song  18 , Xiaoyuan Zhou  19 , Xiaoping Zhang  20 , Shumei Shi  20 , Hong Zhu  21 , Yao Chen  22 , Honglian Yu  21 , Jie Wu  23 , Ruiyun Yu  23 , Wenqiang Fan  23 , Shuang Liu  24 , Jian Xu  24 , Zhibin Chen  25 , Lianjie Shi  26 , Jing He  1 , Xuewu Zhang  1 , Zhanguo Li  27 , Ru Li  27
Affiliations

Comparison of short interval and low dose (SILD) with high dose of cyclophosphamide in the susceptibility to infection in SLE: a multicentrereal-world study

Miao Shao et al. Lupus Sci Med. 2022 Nov.

Abstract

Objective: Infection is a major cause of death in patients with SLE. This study aimed to explore the infection rate in patients with SLE receiving a low dose of intravenous cyclophosphamide (IV-CYC).

Methods: Clinical parameters of 1022 patients with SLE from 24 hospitals in China were collected. Patients were divided into the short-interval and lower-dose (SILD, 400 mg every 2 weeks) IV-CYC group and the high-dose (HD, 500 mg/m2 of body surface area every month) IV-CYC group. The clinical data and infection rate between the two groups were compared.

Results: Compared with HD IV-CYC, the infection rate of the SILD IV-CYC group was significantly lower (13.04% vs 22.27%, p=0.001). Respiratory tract infection (10.28% vs 15.23%, p=0.046) and skin/soft tissue infection (1.78% vs 4.3%, p=0.040) were significantly decreased in the SILD IV-CYC group. Moreover, infections occurred most likely in patients with SLE with leucopenia (OR 2.266, 95% CI 1.322 to 3.887, p=0.003), pulmonary arterial hypertension (OR 2.756, 95% CI 1.249 to 6.080, p=0.012) and >15 mg/day of glucocorticoid (OR 2.220, 95% CI 1.097 to 4.489, p=0.027).

Conclusions: SILD IV-CYC showed a lower frequency of infection events than high-dose IV-CYC in patients with SLE.

Keywords: SLE; cyclophosphamide; therapeutics.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of the selection of patients with SLE. HD IV-CYC, high-dose intravenous cyclophosphamide; IV-CYC, intravenous cyclophosphamide; group 1, the SILD IV-CYC group, short-interval and lower-dose intravenous cyclophosphamide fortnightly with a fixed dose of 400 mg; group 2, the HD IV-CYC group, high-dose intravenous cyclophosphamide monthly at a dose of 500 mg/m2 of body surface area; n, number of patients; SILD IV-CYC, short-interval and lower-dose intravenous cyclophosphamide.
Figure 2
Figure 2
Comparison of the rates of new infection in patients with SLE undergoing SILD IV-CYC and HD IV-CYC treatments. HD IV-CYC, high-dose intravenous cyclophosphamide; M, months; SILD IV-CYC, short-interval lower-dose intravenous cyclophosphamide.
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