title: Corticosteroid Risk Function of Severe Infection in Primary Immune Thrombocytopenia Adults. A Nationwide Nested Case-Control Study.
abstract: Corticosteroid (CS)-related infection risk in immune thrombocytopenia (ITP) is unknown. The aim of this study was to assess the adjusted CS risk function of severe infection in persistent or chronic primary ITP adults. We designed a nested case-control study in the FAITH cohort. This cohort is built through the French national health insurance database named SNIIRAM and includes all treated incident persistent or chronic primary ITP adults in France (ENCePP n°4574). Patients who entered the FAITH cohort between 2009 and 2012 were eligible (n = 1805). Cases were patients with infection as primary diagnosis code during hospitalization. Index date was the date of first hospitalization for infection. A 2:1 matching was performed on age and entry date in the cohort. Various CS exposure time-windows were defined: current user, exposure during the 1/3/6 months preceding index date and from the entry date. CS doses were converted in prednisone equivalent (PEQ). The cumulative CS doses were averaged in each time-window to obtain daily PEQ dosages. Each CS exposure definition was assessed using multivariate conditional regression models. During the study period, 161 cases (9 opportunistic) occurred. The model with the best goodness of fit was CS exposure during the month before the index date (OR: 2.48, 95% CI: 1.61-3.83). The dose-effect relation showed that the risk existed from averaged daily doses ≥5 mg PEQ (vs. <5 mg: 2.09, 95% CI: 1.17-3.71). The risk of infection was mainly supported by current or recent exposure to CS, even with low doses.
authors.affiliation: UMR 1027, INSERM, Université de Toulouse III, Faculté de Médecine, Toulouse, France.|Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.|CIC 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Moulis
authors.affiliation: UMR 1027, INSERM, Université de Toulouse III, Faculté de Médecine, Toulouse, France.|CIC 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Aurore
authors.initials: A
authors.lastname: Palmaro
authors.affiliation: UMR 1027, INSERM, Université de Toulouse III, Faculté de Médecine, Toulouse, France.|Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.|CIC 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Sailler
authors.affiliation: UMR 1027, INSERM, Université de Toulouse III, Faculté de Médecine, Toulouse, France.|CIC 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.|Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, Faculté de Médecine, Toulouse, France.
authors.forename: Maryse
authors.initials: M
authors.lastname: Lapeyre-Mestre
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005602:France; D006801:Humans; D007239:Infections / Q000139:chemically induced* / Q000145:classification; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D011241:Prednisone