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We thank Dr Novikov et al for their letter on the risk of infections of patients with antineutrophil cytoplasm antibody (ANCA)-associated vasculitis and the proposed beneficial effects of hydroxychloroquine (HCQ) to reduce severe infections, as a response to our recently published article ‘Trimethoprim-sulfamethoxazole prophylaxis prevents severe/life-threatening infections following rituximab in antineutrophil cytoplasm antibody-associated vasculitis’.1 2
Modern therapies and adoption of treatment protocols have improved outcome of patients with ANCA-associated vasculitis. Morbidity and mortality, either attributable to the disease or immunosuppressive measures, remain a challenge for the treating physician. A recent meta-analysis of observational studies found a 2.7-fold increased risk of death with a trend towards improved mortality rates in more recent cohorts.3 Among patients recruited into the ‘early trials’ conducted by the European Vasculitis Society (EUVAS), 133 (25%) deaths were recorded over a median follow-up period of 5.2 years. Main causes for death were infections (48%) and active vasculitis (19%) in the first year, while infectious complications remained one of the leading complications leading to mortality (20%) thereafter. Moreover, infections were the leading contributing factor of mortality in this period.4 Several risk factors leading to infections have been identified in …
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