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. 2023 Dec;10(6):1535-1554.
doi: 10.1007/s40744-023-00595-5. Epub 2023 Sep 24.

Association Between Mycophenolate Mofetil Use and Subsequent Infections Among Hospitalized Patients with Systemic Lupus Erythematosus: A Nested Case-Control Study

Qingqing Guo #  1 , Xueyi Zhang #  1 , Siqin Sun #  1 , Xiaojun Tang  2 , Wei Shen  2 , Jun Liang  2 , Genhong Yao  2 , Linyu Geng  2 , Shuai Ding  2 , Hongwei Chen  2 , Hong Wang  2 , Bingzhu Hua  2 , Huayong Zhang  2 , Dandan Wang  2 , Xuebing Feng  2 , Lingyun Sun #  3   4   5 , Ziyi Jin #  6   7
Affiliations

Association Between Mycophenolate Mofetil Use and Subsequent Infections Among Hospitalized Patients with Systemic Lupus Erythematosus: A Nested Case-Control Study

Qingqing Guo et al. Rheumatol Ther. 2023 Dec.

Abstract

Introduction: The association between mycophenolate mofetil (MMF) and infection in patients with systemic lupus erythematosus (SLE) has not been clarified. This study evaluated the degree and factors in effect of MMF use on infection in patients with SLE.

Methods: A hospitalized-based observational study was conducted to collect medical records on patients with SLE during 2010-2021. A nested case-control study was performed among 3339 patients with SLE, including 1577 cases and 1762 controls by whether they developed any type of infection. The exposure of MMF use was determined within 1 year before diagnosed infection or the end of follow-up. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for association between MMF and subsequent infection.

Results: MMF was significantly associated with the risk of overall infection (adjusted OR 1.90, 95% CI 1.48-2.44) and different types of infections, including bacterial infection (adjusted OR 2.07, 95% CI 1.55-2.75), viral infection (adjusted OR 1.92, 95% CI 1.23-3.01), and opportunistic infection (adjusted OR 2.13, 95% CI 1.31-3.46). The top three risks of specific types of infections were bacteremia/septicemia, urinary tract infection/pyelonephritis, and herpes zoster. Stratification analysis showed risk of overall infection increased especially in MMF users with age over 55 years, diabetes, central nervous system involvement, and thrombocytopenia. Moreover, the risk of infection increased with increasing dosage and duration of MMF use. Additionally, the combination of MMF with CYC and other immunosuppressants significantly increases the risk of infections compared to using a single one.

Conclusions: MMF use is associated with various type of infections in patients with SLE, particularly in those with longer use, older age, complications with comorbidities, and concomitant use of CYC or other immunosuppressants.

Keywords: Epidemiology; Immunosuppressive medications; Infection; Mycophenolate mofetil (MMF); Systemic lupus erythematosus (SLE).

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Conflict of interest statement

Qingqing Guo, Xueyi Zhang, Siqin Sun, Xiaojun Tang, Wei Shen, Jun Liang, Genhong Yao, Linyu Geng, Shuai Ding, Hongwei Chen, Hong Wang, Bingzhu Hua, Huayong Zhang, Dandan Wang, Xuebing Feng, Lingyun Sun and Ziyi Jin have nothing to disclose.

Figures

Fig. 1
Fig. 1
Nested case–control study of infection after MMF use developed from a retrospective cohort of patients with SLE. a SLE systemic lupus erythematosus. A longitudinal database for a cohort of hospitalized patients with SLE was established from the medical record system of the Affiliated Drum Tower Hospital, Nanjing University Medical School; the standardized form was used to collect patients’ information from both inpatient and outpatient visits, including basic demographic information, clinical manifestation, laboratory test data, and disease diagnosis medications. b MMF mycophenolate mofetil. The definition of MMF use and all other medications were the presence within 1 year before diagnose infection or the end of follow-up
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References

    1. Rigante D, Mazzoni MB, Esposito S. The cryptic interplay between systemic lupus erythematosus and infections. Autoimmun Rev. 2014;13(2):96–102. - PubMed
    1. Hou C, Jin O, Zhang X. Clinical characteristics and risk factors of infections in patients with systemic lupus erythematosus. Clin Rheumatol. 2018;37(10):2699–2705. - PubMed
    1. Wu XY, Yang M, Xie YS, Xiao WG, Lin J, Zhou B, et al. Causes of death in hospitalized patients with systemic lupus erythematosus: a 10-year multicenter nationwide Chinese cohort. Clin Rheumatol. 2019;38(1):107–115. - PubMed
    1. Thong KM, Chan TM. Infectious complications in lupus nephritis treatment: a systematic review and meta-analysis. Lupus. 2019;28(3):334–346. - PubMed
    1. Barber MRW, Clarke AE. Systemic lupus erythematosus and risk of infection. Expert Rev Clin Immunol. 2020;16(5):527–538. - PubMed

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