FRI0512 Risk of opportunistic infections in patients with antineutrophil cytoplasmic antibody-associated vasculitis using japanese health insurance database
Authors: R. Sakai, E. Tanaka, H. Nishina, H. Yamanaka, M. Harigai
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> It has been reported that patients with antineutrophil cytoplasmic antibody associated vasculitis (AAV) had a high risk of infections<sup>1–3</sup>. Among infections, opportunistic infections (OIs) influence patients' vital prognosis and complicate treatments. It is essential to investigate risk of OIs for appropriate management of patients with AAV. However, data about incidence of OIs and risk factors in patients with AAV is limited to date. <h3>Objectives</h3> To identify incidence and risk factors of OIs under the remission-induction therapy in patients with AAV using Japanese health insurance database. <h3>Methods</h3> This retrospective longitudinal population-based study was conducted using claims data provided by Medical Data Vision Co., Ltd. We defined individuals as AAV cases receiving remission-induction therapy if they met all of the following: 1) had at least one ICD10 code (M300 or M301 or M313 or M318); 2) had at least one prescription of oral corticosteroids (CS) with prednisolone (PSL)-equivalent dosage ≥30 mg/day, methylprednisolone (mPSL) pulse therapy, immunosuppressive drugs (IS) (cyclophosphamide, methotrexate, mycophenolate mofetil), or rituximab during hospitalisation between April 2008 and ;April 2017 and 3) had at least 7 days of hospitalisation. If patients had multiple hospitalizations for AAV remission-induction therapy defined as above, the first hospitalisation between April 2008 and April 2017 was analysed in this study. OIs were defined as follows: at least one ICD10 code and one prescription of predefined drugs for each OI during hospitalisation. We calculated incidence proportion and adjusted odds ratio (OR) of risk factors for OIs using a logistic regression model. <h3>Results</h3> Two thousands and two hundreds ninety nine patients were included in this study. The median age was 73 years and 55.2% were female. The number of patients with ICD10 code M300 for microscopic polyangitis, M301 for eosinophilic granulomatosis with polyangiitis, M313 for granulomatosis with polyangiitis, M318 for AAV, and two or more of these ICD10 codes was 1015 (44.1%), 385 (16.7%), 234 (10.2%), and 665 (28.9%), respectively. mPSL pulse therapy, oral PSL ≥30 mg/d, at least one IS, and rituximab was used in 37.5%, 83.3%, 26.2%, and 5.4%. OI occurred in 203 patients (8.8%) and the most frequent OI was cytomegalovirus infection (n=79, 3.4%). The numbers (%) of candida infection, aspergillus infection, and pneumocystis jirovecii pneumonia were 28 (1.2), 24 (1.0), and 22 (1.0). No case with tuberculosis was observed. After adjusting for comorbidities, age by decade (OR: 1.34 [95% CI, 1.16–1.57]), IS or rituximab use (OR 1.60 [1.17–2.18]), mPSL pulse therapy (OR 2.62 [1.93–3.56]), PSL dosage per 1 mg (OR 1.02 [1.01–1.03]) were associated with occurrence of OIs significantly. <h3>Conclusions</h3> Older age, immunosuppressive treatments were identified as significant risk factors of OIs under the remission-induction therapy in patients with AAV using health insurance database. <h3>References</h3> [1] Eur J Clin Invest2015;45:346–368. [2] Presse Med, 2015;44:e251-e257. [3] Mod Rheumatol2017;27:646–651. <h3>Acknowledgements</h3> This work was supported by AMED under Grant Number JP17ek0109121. <h3>Disclosure of Interest</h3> R. Sakai Grant/research support from: Ayumi Pharmaceutical Co. Ltd., Bristol Meyers Squib, Chugai Pharmaceutical Co. Ltd., Nippon Kayaku Co. Ltd., Taisho Toyama Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corp., E. Tanaka Consultant for: Abbvie, Ayumi Pharmaceutical, Bristol Myers Squibb, Chugai Pharmaceutical, Eisai Pharmaceutical, Nippon Kayaku, Pfizer, Takeda Pharmaceutical, and UCB Pharma, H. Nishina: None declared, H. Yamanaka Grant/research support from: Chugai Pharmaceutical Co. Ltd., Astellas Pharma Inc., Bristol-Meyers Squibb, AbbVie Japan Co. Ltd., Daiichi-Sankyo, Mitsubishi-Tanabe Pharma Corp., Takeda Pharmaceutical Co. Ltd., UCB Japan, Consultant for: Chugai Pharmaceutical Co. Ltd., Astellas, Bristol-Meyers Squibb, AbbVie Japan Co. Ltd., Daiichi-Sankyo, Mitsubishi-Tanabe Pharma Corp., Takeda Pharmaceutical Co. Ltd., UCB Japan, M. Harigai Grant/research support from: Ayumi Pharmaceutical Co. Ltd., Bristol Meyers Squib, Chugai Pharmaceutical Co. Ltd., Nippon Kayaku Co. Ltd., Taisho Toyama Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corp., AbbVie Japan GK, Eisai Co. Ltd., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd