Although a recently available study showed that glucocorticoid monotherapy is known as less effective than combination therapy with an immunosuppressive agent, such as for example RTX or CYC, far away, it really is unknown whether elderly MPA patients who may be at a higher threat of infection should use these aggressive immunosuppressive therapies. dec 2018 immunosuppressive therapy between March 2013 and. The interactions between following and OC serious attacks had been evaluated using multivariate Cox proportional dangers versions, altered for relevant points clinically. Results Through the follow-up period (median, 23?a RS-1 few months; interquartile range, 11C51?a few months), 25 severe infectious shows occurred in 19 sufferers (26.8%) and OC RS-1 occurred in 17 sufferers (23.9%). A log-rank check demonstrated the fact that OC group was connected with serious infections (valueanti-neutrophil cytoplasmic antibody considerably, ANCA-associated vasculitis, microscopic polyangiitis granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, Birmingham Vasculitis Activity Rating, myeloperoxidase, proteinase-3, dental candidiasis, methylprednisolone Baseline features were not different significantly between the OC and non-OC groups. Methylprednisolone pulse therapy was administered in 15 (27.8%) and 9 (52.9%) patients in the non-OC and OC groups, respectively ( 0.001). The cumulative probabilities of severe infection within 6, 12, and 24 months were 0.18, 0.33, and 0.49 for the OC group and 0.02, 0.08, and 0.05 for the non-OC group, respectively, that is, significant differences in the occurrence of severe infection were found in the OC and non-OC groups (pneumonia (bacteremia (valuevaluehazard ratio, confidence interval Data are the HR, 95% CI, and value from Cox proportional hazard regression analyses Adjusted for baseline characteristics including age, sex, serum albumin level, serum creatinine level, methylprednisolone pulse therapy, and oral candidiasis During the observation period before the occurrence of severe infection (or censoring without outcome), no significant difference was observed between the OC and non-OC groups in terms of the point and cumulative PSL dose, and using immunosuppressants at 0, 3, 6, 12, and 24?months after initiating immunosuppressive therapy (Table ?(Table3).3). These data suggest that differences in the intensity of immunosuppressive therapy between OC and non-OC groups did not explain the differences in the occurrence of severe infection. Table 3 Immunosuppressive treatment during the observation period valuespecies, and the most common is . The reported risk factors for OC were broad-spectrum antibiotics, immunosuppressive drugs, smoking, diabetes, Cushings syndrome, immunosuppressive conditions such as human immunodeficiency virus infection, malignancies such as leukemia, and nutritional deficiencies . In this study, we considered that in AAV patients, OC might be an important sign of decreased cellular immune function, predisposing the patient further to subsequent severe infections. This study also showed that glucocorticoid dose and use of immunosuppressive treatment during the observation period were clinically comparative between the OC and non-OC groups, suggesting that differences in the intensity of immunosuppressive therapy between OC and non-OC Rabbit Polyclonal to OR52N4 did not explain the differences in the occurrence of severe infections. Interestingly, this study also showed an interaction between OC and methylprednisolone pulse therapy, suggesting that patients who developed OC under strong immunosuppressive therapy might have an increased risk of severe infection. Regarding OC treatment, although all patients were prescribed oral antifungal drugs such as itraconazole or fluconazole for systemic effects, we consider that OC treatment itself does not directly influence the outcome of severe infection. As immunosuppressive therapy, glucocorticoid RS-1 monotherapy was frequently used for the treatment of AAV in the present study based on previous Japanese studies [29, 30]. Although a recent study showed that glucocorticoid monotherapy is considered less effective than combination therapy with an immunosuppressive agent, such as CYC or RTX, in other countries, it is unknown whether elderly MPA patients who might be at a high risk of infection should use these aggressive immunosuppressive therapies. In our cohort, glucocorticoid monotherapy was frequently used for elderly patients.