Serious infections in patients with systemic lupus erythematosus: how can we prevent them?

Systemic lupus erythematosus (SLE) is an autoimmune disease with increased morbidity and mortality compared with the general population. The overall survival of patients with SLE has improved considerably in recent decades, notably through better recognition and earlier diagnosis of the disease and its complications and better management, with use of glucocorticoids, disease-modifying anti-rheumatic drugs (DMARDs), and immunosuppressants. Although often preventable, infections still represent one of the leading causes of morbidity and mortality in patients with SLE. 1 Tektonidou MG Lewandowski LB Hu J Dasgupta A Ward MM Survival in adults and children with systemic lupus erythematosus: a systematic review and Bayesian meta-analysis of studies from 1950 to 2016. Ann Rheum Dis. 2017; 76: 2009-2016 Crossref PubMed Scopus (132) Google Scholar The relatively recent use of biological DMARDs, such as rituximab or belimumab, also raises questions concerning the risk of infection. Early infection risk in patients with systemic lupus erythematosus treated with rituximab or belimumab from the British Isles Lupus Assessment Group Biologics Register (BILAG-BR): a prospective longitudinal studyIn patients with moderate-to-severe SLE, rituximab, belimumab, and standard immunosuppressive therapy have similar serious infection risks. Key risk factors for serious infections included multimorbidity, hypogammaglobulinaemia, and increased glucocorticoid doses. When considering the risk of serious infection, we propose that immunosupppressives, rituximab, and belimumab should be prioritised as mainstay therapies to optimise SLE management and support proactive minimisation of glucocorticoid use. Full-Text PDF Open Access