Lupus & antiphospholipid syndrome
Comparative Safety of Common Immunosuppressant Therapies in Systemic Lupus Erythematosus: A Target Trial Emulation Study
Authors' conclusion
Initial differences in the infection-related hospitalization risk were attenuated after accounting for time-varying glucocorticoid exposure.
Study context
- Population
- Patients with nonrenal SLE initiating common immunosuppressants, March 2011–September 2023; excluded prior LN, solid-organ or bone marrow transplantation, or RTX/CYC exposure
- Participants
- 6,168 patients
- Comparison
- Azathioprine vs belimumab vs methotrexate vs MPAAs
- Outcome
- Time to first infection-related hospitalisation
Methodological detailsclaims data (Optum Labs Data Warehouse), inverse probability of treatment weighting, marginal structural Cox models, intention-to-treat and per-protocol analyses
- Claims data (Optum Labs Data Warehouse)
- Inverse probability of treatment weighting
- Marginal structural Cox models
- Intention-to-treat and per-protocol analyses
Main finding
As reported in the abstract
Infection-related hospitalisation, cumulative incidence · 24 months
Hazard ratio (95% CI)
MPAAsvs Belimumab
1.55(1.07–2.25)
MPAAsvs Methotrexate
1.32(1.04–1.68)
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Infection-related hospitalisation, per-protocol analysisAzathioprinevs BelimumabPP · per-protocol (PP) | 2.04 (1.01–4.16) | |
| Infection-related hospitalisation, per-protocol analysisMPAAsvs BelimumabPP · per-protocol (PP) | 2.27 (1.11–4.62) | |
| 0.20.5125Hazard ratio (log scale) |
Infection-related hospitalisation after accounting for time-varying monthly GC dose
- Between-treatment differences no longer significant
Original publication
Comparative Safety of Common Immunosuppressant Therapies in Systemic Lupus Erythematosus: A Target Trial Emulation Study. Arthritis Rheumatol. Published 17 September 2026. doi:10.
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