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Abstract: SA-OR064

Infectious Complications in Lupus Nephritis Treatment: A Systematic Review and Meta-Analysis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Thong, Kah Mean, Queen Mary Hospital , Pokfulam, HKSAR, HONG KONG, China
  • Chan, Daniel Tak Mao, Queen Mary Hospital , Pokfulam, HKSAR, HONG KONG, China
Background

Infection is an important concern in lupus nephritis treatment, but few studies have primarily focused on this complication. We investigated the incidence rate of infections, their associated risk factors, and outcomes reported in the literature.

Methods

Randomized controlled trials (RCTs) on lupus nephritis Class III/IV/V published between January 1980 and December 2016 and identified from Pubmed/Medline were included in the meta-analysis. Infection risk associated with different immunosuppressive medications was presented as risk ratio (RR) with 95% confidence interval (CI) using the Mantel-Haenszel method.

Results

Thirty-two RCTs involving 3834 patients were included. Estimated incidence rates of overall and serious infections were both higher during the induction phase than maintenance phase. The rate of serious infections ranged from 8.2-50 per 100 patient-years during the induction phase, and 3.5 per 100 patient-years during maintenance phase. The rates of serious infections were 4.1-25% in Asia and 4.4-8.5% in non-Asian countries; with infection-related mortality rates of 0-6.7% in Asian, compared to 0-2.1% in non-Asian locations. Mycophenolate mofetil as induction treatment was associated with lower overall infection risks than cyclophosphamide in non-Asian countries (RR, 0.60; 95% CI, 0.48–0.75; p<0.001). Recent data (since 2011), predominantly from Asia, suggested that tacrolimus used as induction immunosuppression was associated with lower rates of overall infections compared with mycophenolate mofetil (RR, 0.50; 95% CI, 0.33–0.76; p=0.001).

Conclusion

Infection remains a serious complication in patients with lupus nephritis, especially in Asia, but the reported rates varied markedly. Mycophenolate mofetil was associated with lower infection rates in non-Asian patients, compared with cyclophosphamide; and further experience is required to confirm the infection risk associated with tacrolimus.

Funding

  • Private Foundation Support