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. 2023 Jun 1:14:1185809.
doi: 10.3389/fphar.2023.1185809. eCollection 2023.

Traditional Chinese medicine use is associated with lower risk of pneumonia in patients with systemic lupus erythematosus: a population-based retrospective cohort study

Weijie Wang  1   2 , Yu-Hsun Wang  3 , Kepeng Yang  1 , Xiangsheng Ye  4 , Xinchang Wang  1 , James Cheng-Chung Wei  5   6   7   8
Affiliations

Traditional Chinese medicine use is associated with lower risk of pneumonia in patients with systemic lupus erythematosus: a population-based retrospective cohort study

Weijie Wang et al. Front Pharmacol. .

Abstract

Objectives: To investigate the association between traditional Chinese medicine (TCM) therapy and the risk of pneumonia in patients with systemic lupus erythematosus (SLE). Methods: This population-based control study analyzed the data retrieved from the National Health Insurance Research database in Taiwan. From a cohort of 2 million records of the 2000-2018 period, 9,714 newly diagnosed patients with SLE were initially included. 532 patients with pneumonia and 532 patients without pneumonia were matched 1:1 based on age, sex, and year of SLE diagnosis using propensity score matching. The use of TCM therapy was considered from the SLE diagnosis date to the index date and the cumulative days of TCM therapy were used to calculate the dose effect. Conditional logistic regression was used to investigate the risk of pneumonia infection. Furthermore, to explore the severity of pneumonia in SLE, sensitivity analyses were performed after stratification using the parameters of emergency room visit, admission time, and antibiotic use. Results: TCM therapy for >60 days could significantly reduce the risk of pneumonia in patients with SLE (95% CI = 0.46-0.91; p = 0.012). Stratified analysis showed that TCM use also reduced the risk of pneumonia in younger and female patients with SLE by 34% and 35%, respectively. TCM for >60 days significantly reduced the risk of pneumonia in the follow-up periods of >2, >3, >7, and >8 years. In addition, the exposure of TCM for >60 days reduced the risk of pneumonia in patients with SLE who were treated with antibiotics for moderate or severe pneumonia. Finally, the study found that using formulae to tonify the kidney for more than 90 days and formulae to activate blood circulation for less than 30 days could significantly reduce the risk of pneumonia infection in patients with SLE. Conclusion: TCM use is associated with a lower risk of pneumonia among patients with SLE.

Keywords: cohort; infection; pneumonia; systemic lupus erythematosus (SLE); traditional Chinese medicine (TCM).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of the study design. SLE, systemic lupus erythematosus; OPD, Outpatient department.
FIGURE 2
FIGURE 2
Conditional logistic regression of risk of pneumonia by follow-up duration stratification (60 days). †Adjusted for hypertension, hyperlipidemia, chronic liver disease, chronic kidney disease, rheumatoid arthritis, corticosteroids, NSAIDs, and hydroxychloroquine.
FIGURE 3
FIGURE 3
Conditional logistic regression of risk of pneumonia by antibiotics use, severity of pneumonia and days of hospitalization. ER, emergency room. †Adjusted for all variables.
FIGURE 4
FIGURE 4
Conditional logistic regression of risk of pneumonia by different formulae of TCM. † Adjusted for hypertension, hyperlipidemia, chronic liver disease, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, rheumatoid arthritis, ankylosing spondylitis, corticosteroids, NSAIDs, hydroxychloroquine, and methotrexate. KF: Chinese formulae tonifying the kidney; BF: Chinese formulae activating blood circulation.
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