No difference in serious infection rates between SLE treatments




There was no significant difference in serious infection and mortality rates between mycophenolate mofetil (MMF), azathioprine (AZA), and cyclophosphamide (CYC) for high-risk systemic lupus erythematosus patients who were newly initiating immunotherapy, according to Candace H. Feldman, MD, and her associates.

In a 6-month analysis of 1,350 systemic lupus erythematosus patients initiating MMF and 1,350 patients initiating AZA, the incidence rate of first hospitalized infection per 100 person-years for MMF users was 14.6, and the incidence rate for AZA was 15.2. In a separate 6-month analysis of 674 patients initiating MMF and 674 patients receiving CYC, the incidence rate of first hospitalized infection per 100 person-years was 24.1 for MMF and 24.6 for CYC. The hazard ratio for AZA was 0.99, and for CYC it was 0.95.

Mortality was also similar in both cohorts. In the MMF vs. AZA cohort, 13 deaths were reported in the MMF group, and 14 were reported in the AZA group. In the MMF vs. CYC cohort, 15 deaths were reported in each group. The hazard ratio for mortality in the AZA group was 0.90, and the HR for mortality in the CYC group was 0.95.

“Based on these findings, concerns about differential infection risks may not need to influence physician and patient choice between MMF vs. AZA and MMF vs. CYC, even in a population highly susceptible to adverse outcomes,” the investigators concluded.

Find the full study in Arthritis & Rheumatology (doi: 10.1002/art.39849).

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