title: Infections in non-splenectomized persistent or chronic primary immune thrombocytopenia adults: risk factors and vaccination effect.
abstract: Essentials The risk factors for infection in immune thrombocytopenia are not well known. We conducted a national pharmacoepidemiological study. Pulmonary disease, corticosteroids and rituximab were the main risk factors for infections. Pneumococcal and influenza vaccines were protective against infections.
  
  
  
  Introduction Risk factors for infection and protective effect of vaccines in immune thrombocytopenia (ITP) patients in the era of rituximab therapy are unknown. Objectives To assess the risk factors for serious and non-serious infections (respectively, SIs and NSIs) in non-splenectomized adults treated for persistent or chronic primary ITP, including the effect of pneumococcal and influenza vaccines. Patients/Methods The population was the 2009-2012 FAITH cohort (n = 1805), which is the cohort of all incident (newly diagnosed) primary ITP adults treated > 3 months in France built into the national health insurance database (SNIIRAM). SIs were hospitalizations with any infection as the primary diagnosis code. NSIs were identified using out-of-hospital antibiotic dispensing. Cox models were performed. Results Incidence rates were 6.3/100 patient-years (95% confidence interval [CI], 5.4-7.4) for SIs (lower respiratory tract in 42.8% of the cases) and 100.5/100 patient-years (95% CI, 95.0-106.3) for NSIs. In multivariate analyses, increasing age and chronic pulmonary disease were associated with both SI and NSI occurrence. The hazard ratios (HRs) for corticosteroids and rituximab were, respectively, 3.83 (95% CI, 2.76-5.31) and 2.60 (95% CI, 1.67-4.03) for SIs and 2.46 (95% CI, 2.19-2.76) and 1.49 (95% CI, 1.28-1.74) for NSIs. Pneumococcal vaccine showed a protective effect for both SIs and NSIs (0.38 [95% CI, 0.20-0.73] and 0.52 [95% CI, 0.43-0.65], respectively), as did influenza vaccine (0.42 [95% CI, 0.27-0.64] and 0.49 [95% CI, 0.41-0.59], respectively). Conclusions Chronic pulmonary disease, corticosteroids and rituximab are the main risk factors for infections, whereas pneumococcal and influenza vaccines are protective against SIs and NSIs.
authors.affiliation: UMR 1027, INSERM, Université de Toulouse III, Toulouse, France.|Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.|Centre d'Investigation Clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: G
authors.identifier: 0000-0001-9953-4640
authors.initials: G
authors.lastname: Moulis
authors.affiliation: UMR 1027, INSERM, Université de Toulouse III, Toulouse, France.|Centre d'Investigation Clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.|Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: M
authors.initials: M
authors.lastname: Lapeyre-Mestre
authors.affiliation: UMR 1027, INSERM, Université de Toulouse III, Toulouse, France.|Centre d'Investigation Clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Palmaro
authors.affiliation: UMR 1027, INSERM, Université de Toulouse III, Toulouse, France.|Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.|Centre d'Investigation Clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: L
authors.initials: L
authors.lastname: Sailler
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005602:France; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D008171:Lung Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications*; D012307:Risk Factors; D000069283:Rituximab / Q000009:adverse effects* / Q000627:therapeutic use; D013154:Spleen; D013156:Splenectomy; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines; D000069283:Rituximab
keywords: glucocorticoids; immune thrombocytopenia; infection; rituximab; vaccine