Results indicated that after six months, the incidence rate per 100 person-years for first serious hospitalized infection was 14.6 and 15.2 in patients treated with MMF and AZA, respectively (HR of MMF vs. AZA 0.99 [95% CI 0.74–1.32]). Similarly, a comparison of first serious infection between MMF and CYC revealed the incidence rate per 100 person-years was 24.1 and 24.6, respectively (HR 0.95 [95% CI 0.69–1.32]). Researchers also found that there were no differences in death rates among the three regimens.
Although “no differences were observed in our analyses between the specific immunosuppressive drug comparisons, the high burden of serious infections among SLE patients receiving these medications overall is important to consider,” the article states.
The lack of differences among the drugs studied with regard to serious infections could be useful from a clinical standpoint to assist physicians when treating lupus….Choosing one of these drugs over the other is not going to increase the patient’s risk of serious infection.
Practically Speaking
The lack of differences among the drugs studied with regard to serious infections could be useful from a clinical standpoint to assist physicians when treating lupus, Dr. Feldman says.
Rheumatologists often have a patient with a number of recurring infections. “It will be your time to choose their next drug,” Dr. Feldman explains. “You [should ask yourself, ‘Which] of the drugs I would potentially prescribe [has] the lowest risk of serious infection associated with it?’”
One thing this study reveals is that choosing one of these drugs over the other is not going to increase the patient’s risk of serious infection, Dr. Feldman says.
“[Patients] are going to have an increased risk just by virtue of being put on either immunosuppressive drug, but one drug does not appear to have a stronger association with serious infections than the other,” she says.
More Research Required
Dr. Feldman says there is room for further studies to investigate whether there is any difference in risk of infection after longer-term use of the medications included in the analysis.
Catherine Kolonko is a medical writer based in Oregon.
Reference
- Feldman CH, Marty FM, Winkelmayer WC, et al. Comparative rates of serious infections among patients with systemic lupus erythematosus receiving immunosuppressive medications. Arthritis Rheumatol. 2017 Feb;69(2):387–397.
