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Background <p>Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) has improved survival outcomes with advancements in immunosuppressive therapies; however, the increased incidence of infections remains a significant concern. Reports on infection risk factors other than age are limited, especially in older adults with AAV who are at a higher risk.</p> Methods <p>We aimed to identify the risk factors for early-phase infection during treatment initiation in older adults (aged ≥ 75 years) with myeloperoxidase (MPO)-ANCA-positive AAV (MPO-AAV). This was a single-center, retrospective observational study that included 50 patients who were classified as having microscopic polyangiitis. Severe infections were defined as those requiring hospitalization within six months of treatment initiation.</p> Results <p>Severe infections occurred in 17 (34%) patients. No statistically significant associations were observed between disease incidence and either combined immunosuppressive therapy or organ-specific lesions. However, trimethoprim-sulfamethoxazole (TMP-SMX) was significantly associated with a reduced risk of infection. This association remained statistically significant after adjustment for sex (hazard ratio, 0.23; 95% CI, 0.08–0.64; <i>P</i> &lt; 0.01).</p> Conclusions <p>In older adults with MPO-AAV, TMP-SMX use was associated with a reduced risk of early severe infection. Although limited by the observational nature of the study, these findings suggest a potential role for TMP-SMX prophylaxis in high-risk elderly populations.</p> Clinical trial number <p>Not applicable.</p>

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Trimethoprim-sulfamethoxazole and the risk of early severe infection in elderly-onset myeloperoxidase-antineutrophil cytoplasmic antibody-associated vasculitis

  • 期刊论文

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  • 发表日期：

    2025年12月17日

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  • Shun Yoshida,
  • Kohei Yamamura,
  • Keiichi Osano,
  • Miho Shikata,
  • Toshihisa Ishii,
  • Makiko Konishi,
  • Kazuya Takahashi,
  • Daiki Nakagomi,
  • Kohei Uchimura,
  • Ayumu Nakashima

摘要

Background

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) has improved survival outcomes with advancements in immunosuppressive therapies; however, the increased incidence of infections remains a significant concern. Reports on infection risk factors other than age are limited, especially in older adults with AAV who are at a higher risk.

Methods

We aimed to identify the risk factors for early-phase infection during treatment initiation in older adults (aged ≥ 75 years) with myeloperoxidase (MPO)-ANCA-positive AAV (MPO-AAV). This was a single-center, retrospective observational study that included 50 patients who were classified as having microscopic polyangiitis. Severe infections were defined as those requiring hospitalization within six months of treatment initiation.

Results

Severe infections occurred in 17 (34%) patients. No statistically significant associations were observed between disease incidence and either combined immunosuppressive therapy or organ-specific lesions. However, trimethoprim-sulfamethoxazole (TMP-SMX) was significantly associated with a reduced risk of infection. This association remained statistically significant after adjustment for sex (hazard ratio, 0.23; 95% CI, 0.08–0.64; P < 0.01).

Conclusions

In older adults with MPO-AAV, TMP-SMX use was associated with a reduced risk of early severe infection. Although limited by the observational nature of the study, these findings suggest a potential role for TMP-SMX prophylaxis in high-risk elderly populations.

Clinical trial number

Not applicable.