LAUSR

Background Infections continue to be an important source of morbidity and mortality in systemic lupus erythematosus (SLE).1 Susceptibility to infections is thought to be due to a combination of disease related factors and immunosuppression, however differential contributions during disease course has not been yet studied. Objectives Using data of patients from the longitudinal inception cohort Registro Español de Lupus Eritematoso Sistémico (RELES), we aimed to analyse how predictors of infection change during the course of the disease.2 Methods Two hundred and eighty-two patients from the RELES cohort were included. Markers of lupus activity, average prednisone doses and use of immunosuppressive drugs were compared between patients with and without infections within the first and second year of disease. For the analysis, drugs given during the first month of follow-up were considered for infections during the first year and medications given during the first year were considered for infections during the second.3 Results Nineteen patients (6.4%) had a documented episode of infection during the first year of follow-up and 16 patients 8 (5.67%) during the second. The following variables were associated with infections during the first year: hypocomplementemia at diagnosis (p=0.01), nephritis at diagnosis (p=0.03), SLEDAI score (p<0.01), average dose of prednisone higher than 30 mg/day (p=0.01), methylprednisolone pulses (p=0.05) and mycophenolate use (p=0.02). The independent variables in the final model were hypocomplementemia (OR 4.41, 95% CI 0.96–20.2) and average dose of prednisone higher than 30 mg/day (OR 6.60, 95% CI 1.3–32.4). The following variables were predictors of infections during the second year in the univariate analysis: average dose of prednisone higher than 7.5 mg/day (p=0.05), methylprednisolone pulses (p=0.07), duration of therapy with antimalarials (p=0.09), mycophenolate use (p=0.01) and cyclophosphamide use (p=0.05). The independent variables in the final model were average dose of prednisone higher than 7.5 mg/day (OR 4.5, 95% CI 0.99–21) and duration of therapy with antimalarials as a protective factor (OR 0.99, 95% CI 0.99–1.00). Conclusions Patients with high baseline activity are at a higher risk of infection during the first months but intensive lupus therapy, specifically with medium-high doses of prednisone, is the strongest predictor of infectious events. Continued use of antimalarials protects from infections. References [1] Danza A., Ruiz-Irastorza G. Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies. Lupus. 2013Oct;22(12):1286–94 [2] Ruiz-Irastorza, et al. Patterns of drug therapy in newly diagnosed Spanish patients with systemic lupus erythematosus. Clin Exp Rheumatol. 2016 May-Jun;34(3):466–72 [3] Ruiz-Irastorza, et al. First month prednisone dose predicts prednisone burden during the following 11 months: an observational study from the RELES cohort. Lupus Sci Med. 2016Aug 2;3(1) Disclosure of Interest None declared