POS0426 EXPLORING FACTORS ASSOCIATED WITH THE DEVELOPMENT OF OPPORTUNISTIC FUNGAL INFECTIONS IN RHEUMATOID ARTHRITIS PATIENTS
Authors: A. Purschke, M. Schaefer, B. Manger, M. Schneider, M. Feuchtenberger, C. Moebius, A. Strangfeld
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Data on the incidence and risk of opportunistic fungal infections (OFIs), rare yet life-threatening infections in rheumatoid arthritis (RA) patients[1], remain scarce due to limited patient numbers and inconsistent case definitions. <h3>Objectives:</h3> To investigate associations between demographic and clinical characteristics, treatment, and the development of OFI in RA patients. <h3>Methods:</h3> Data were obtained from the German biologics register RABBIT, which includes adult RA patients starting a new treatment with a biologic (b) or targeted synthetic (ts) disease-modifying anti-rheumatic drug (DMARD) or a conventional synthetic (cs) DMARD after at least one csDMARD failure. Fungal infections reported between 05/2001 and 12/2022 were considered opportunistic when meeting the consensus definitions by Winthrop et al.[2] or when causing esophagitis. Patients who had developed an OFI were matched 1:5 to RA controls by age and enrolment year. Associations between OFI development and patient characteristics at last visit prior to mycosis onset (see Table 1) were assessed using multivariable logistic regression, analysing sex, smoking history, disease duration, glucocorticoid (GC) use, disease activity (DAS28-ESR), sum of comorbidities predisposing for infection (malignancies, diabetes mellitus, kidney disease, lung disease, autoimmune disease, liver disease, blood count disorder), therapy with b/tsDMARDs, number of previous DMARDs, and type of enrolling institution. Multiple imputation of missing values was performed. <h3>Results:</h3> Among 20,907 RA patients contributing 101,778 patient-years (PY) to RABBIT, 105 developed an OFI (1.03/1,000 PY), caused by Candida ssp. (60 %), Pneumocystis jirovecii (20 %), Aspergillus ssp. (7 %), and unknown fungal genus (13 %). Nineteen patients died from or with infection (18 % of all OFIs and 34 % of 56 invasive OFIs). Higher disease activity (OR 1.18, 95% CI: 1.01 – 1.37 per point of DAS28-ESR), a daily prednisolone-equivalent dose of &gt; 5 mg (OR 2.11, 95% CI:1.16 – 3.82), smoking history among men (OR 2.69, 95% CI:1.58 – 4.59), a higher number of relevant comorbidities (OR 1.62, 95% CI: 1.29 – 2.03 per additional comorbidity), and type of enrolling institution (OR for clinic vs. practice: 1.39, 95% CI: 1.00 – 1.92) were associated with a higher odds of OFIs (see Figure 1). <h3>Conclusion:</h3> Our study underlines the rarity of OFIs in RA patients, yet revealing a notable mortality. The development of OFIs was associated with higher disease activity, GC use &gt; 5 mg per day, smoking history among men, and a higher number of relevant comorbidities. Further research is essential to investigate the risk profile by DMARD class, enhancing our understanding of potential causal relationships. <h3>REFERENCES:</h3> [1] PMID: 27032792. [2] PMID: 26395500. <h3>Acknowledgements:</h3> RABBIT is currently supported by a joint, unconditional grant from AbbVie, Amgen, BMS, Celltrion, Fresenius Kabi, Galapagos, Hexal, Lilly, MSD, Pfizer, Samsung Biogen, Sanofi, Biocon, UCB and previously by Roche. <h3>Disclosure of Interests:</h3> Alina Purschke: None declared, Martin Schaefer: None declared, Bernhard Manger Abbvie, Alexion, Astra-Zeneca, EUSA, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Pharming, EUSA, Vifor, Matthias Schneider AstraZeneca, GSK, Pfizer, Abbvie, AstraZeneca, GSK, Otsuka, UCB, AstraZeneca, GSK, Martin Feuchtenberger Abbvie, Novartis, Rheumaakademie, Abbvie, Biogen, BMS, Boehringer, Lilly, MSD, Novartis, Pfizer, Charlotte Moebius UCB, Pfizer, Lilly, UCB, Pfizer, Lilly, Anja Strangfeld AbbVie, Biogen, Galapagos, Janssen, Lilly, Pfizer, Takeda.