Traditional Chinese medicine use is associated with lower risk of pneumonia in patients with systemic lupus erythematosus: a population-based retrospective cohort study

Weijie Wang; Yu-Hsun Wang; Kepeng Yang; Xiangsheng Ye; Xinchang Wang; James Cheng-Chung Wei

doi:10.3389/fphar.2023.1185809

Traditional Chinese medicine use is associated with lower risk of pneumonia in patients with systemic lupus erythematosus: a population-based retrospective cohort study

Front Pharmacol. 2023 Jun 1:14:1185809. doi: 10.3389/fphar.2023.1185809. eCollection 2023.

Authors

Weijie Wang^{1

2}, Yu-Hsun Wang³, Kepeng Yang¹, Xiangsheng Ye⁴, Xinchang Wang¹, James Cheng-Chung Wei^{5

6

7

8}

Affiliations

¹ Department of Rheumatology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
² Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Science, Beijing, China.
³ Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
⁴ The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
⁵ Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.
⁶ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁷ Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
⁸ Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.

Abstract

Objectives: To investigate the association between traditional Chinese medicine (TCM) therapy and the risk of pneumonia in patients with systemic lupus erythematosus (SLE). Methods: This population-based control study analyzed the data retrieved from the National Health Insurance Research database in Taiwan. From a cohort of 2 million records of the 2000-2018 period, 9,714 newly diagnosed patients with SLE were initially included. 532 patients with pneumonia and 532 patients without pneumonia were matched 1:1 based on age, sex, and year of SLE diagnosis using propensity score matching. The use of TCM therapy was considered from the SLE diagnosis date to the index date and the cumulative days of TCM therapy were used to calculate the dose effect. Conditional logistic regression was used to investigate the risk of pneumonia infection. Furthermore, to explore the severity of pneumonia in SLE, sensitivity analyses were performed after stratification using the parameters of emergency room visit, admission time, and antibiotic use. Results: TCM therapy for >60 days could significantly reduce the risk of pneumonia in patients with SLE (95% CI = 0.46-0.91; p = 0.012). Stratified analysis showed that TCM use also reduced the risk of pneumonia in younger and female patients with SLE by 34% and 35%, respectively. TCM for >60 days significantly reduced the risk of pneumonia in the follow-up periods of >2, >3, >7, and >8 years. In addition, the exposure of TCM for >60 days reduced the risk of pneumonia in patients with SLE who were treated with antibiotics for moderate or severe pneumonia. Finally, the study found that using formulae to tonify the kidney for more than 90 days and formulae to activate blood circulation for less than 30 days could significantly reduce the risk of pneumonia infection in patients with SLE. Conclusion: TCM use is associated with a lower risk of pneumonia among patients with SLE.

Keywords: cohort; infection; pneumonia; systemic lupus erythematosus (SLE); traditional Chinese medicine (TCM).

Grants and funding

This research was supported by National Natural Science Foundation of China (grant number: 82004238), Natural Science Foundation of Zhejiang Province (grant number: LBY21H270001), China Postdoctoral Fund (grant number: 2019M660952), Zhejiang Medicine and Health Science and Technology Project (grant number: 2021KY843) and Young Elite Scientists Sponsorship Program by CACM (grant number: CACM2021-QNRC2-B01).