2009 年至 2021 年系统性红斑狼疮患儿和青少年的住院感染和利妥昔单抗治疗。
Hospitalised infections and rituximab administration among children and adolescents with systemic lupus erythematosus from 2009 to 2021.
机构信息
Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
出版信息
Lupus Sci Med. 2024 Sep 12;11(2):e001210. doi: 10.1136/lupus-2024-001210.
BACKGROUND
Rituximab is associated with high infection rates, but studies of infections following rituximab in youth with childhood-onset SLE (cSLE) are limited. We conducted a retrospective longitudinal cohort study to assess the incidence of hospitalised infections following rituximab among children with cSLE and to assess changes in hospital-based rituximab administration over time.
METHODS
Youth ages 2-21 years with an International Classification of Diseases (ICD) code for SLE who received rituximab during admission to a Pediatric Health Information System hospital from 2009 to 2021 were included. Incidence rates for infections requiring hospitalisation over the 12 months following first rituximab administration were calculated. Rituximab use by year of hospital discharge was tabulated.
RESULTS
We identified 1567 children with cSLE who received rituximab. 219 children were admitted with an infection within 1 year after first rituximab administration, for an incidence rate of 140 cases per 1000 patient-years. Seven children (0.44%) died during a hospitalisation with an infection in the year following rituximab administration. The most common hospitalised infections were bacterial pneumonia, sepsis and cellulitis. 12 children were hospitalised with COVID-19, none of whom died. Hospitalisations with rituximab administered decreased from 2019 to 2021.
CONCLUSIONS
In this cohort of patients with cSLE who received inpatient treatment with rituximab, we observed a 14% rate of hospitalisation with infection in the year following rituximab administration among youth with cSLE. Rituximab use declined during the COVID-19 pandemic. No fatalities with COVID-19 were observed. Given the lack of outpatient data, including doses of concomitant medications and disease activity measures, further research is needed to identify risk factors for infection following rituximab among children with cSLE.
背景
利妥昔单抗与高感染率相关，但关于儿童发病的幼年特发性系统性红斑狼疮（cSLE）患者使用利妥昔单抗后的感染情况的研究有限。我们进行了一项回顾性纵向队列研究，以评估 cSLE 患儿接受利妥昔单抗治疗后住院感染的发生率，并评估随时间推移利妥昔单抗在医院内使用的变化。
方法
2009 年至 2021 年期间，在一家儿科健康信息系统医院住院的符合国际疾病分类（ICD）SLE 编码的 2-21 岁青少年，接受利妥昔单抗治疗，纳入本研究。计算首次利妥昔单抗治疗后 12 个月内需要住院治疗的感染发生率。按出院年份汇总利妥昔单抗的使用情况。
结果
我们共确定了 1567 例接受利妥昔单抗治疗的 cSLE 患儿。1567 例患儿中有 219 例在首次利妥昔单抗治疗后 1 年内入院时发生感染，感染发生率为每 1000 患者年 140 例。在利妥昔单抗治疗后 1 年内，有 7 例患儿（0.44%）在发生感染的住院期间死亡。最常见的住院感染是细菌性肺炎、败血症和蜂窝织炎。有 12 例患儿因 COVID-19 住院，均未死亡。2019 年至 2021 年期间，因利妥昔单抗而住院的患儿人数减少。
结论
在本队列中，接受住院治疗的 cSLE 患儿在接受利妥昔单抗治疗后 1 年内，有 14%的患儿在 cSLE 后发生感染需要住院治疗。在 COVID-19 大流行期间，利妥昔单抗的使用减少。未观察到 COVID-19 死亡病例。鉴于缺乏门诊数据，包括同时使用的药物剂量和疾病活动度指标，需要进一步研究以确定 cSLE 患儿接受利妥昔单抗治疗后感染的风险因素。
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