Prophylaxis for Pneumocystis pneumonia in patients with rheumatoid arthritis treated with biologics, based on risk factors found in a retrospective studyReport as inadecuate




Prophylaxis for Pneumocystis pneumonia in patients with rheumatoid arthritis treated with biologics, based on risk factors found in a retrospective study - Download this document for free, or read online. Document in PDF available to download.

Arthritis Research and Therapy

, 16:R43

First Online: 05 February 2014Received: 28 July 2013Accepted: 28 January 2014

Abstract

IntroductionPneumocystis pneumonia PCP is one of the most prevalent opportunistic infections in patients undergoing immunosuppressive therapy. In this article, we discuss risk factors for PCP development in patients with rheumatoid arthritis RA during the course of biologic therapy and describe a prophylactic treatment for PCP with trimethoprim-sulfamethoxazole TMP-SMX. We also evaluate the effectiveness and safety of the treatment.

MethodsWe retrospectively analyzed 702 RA patients who received biologic therapy and compared the characteristics of patients with vs. without PCP to identify the risk factors for PCP. Accordingly, we analyzed 214 patients who received the TMP-SMX biologic agents as prophylaxis against PCP at the start of treatment to evaluate their effectiveness and safety.

ResultsWe identified the following as risk factors for PCP: age at least 65 years hazard ratio HR = 4.37, 95% confidence interval CI = 1.04 to 18.2, coexisting pulmonary disease HR = 8.13, 95% CI = 1.63 to 40.0, and use of glucocorticoids HR = 11.4, 95% CI = 1.38 to 90.9. We employed a protocol whereby patients with two or three risk factors for PCP would receive prophylactic treatment. In the study with 214 patients, there were no cases of PCP, and the incidence of PCP was reduced to 0.00 per 100 person-years compared with that before the procedure 0.93 per 100 person-years. There were no severe adverse events induced by the TMP-SMX treatment.

ConclusionsRA patients with two or three risk factors for PCP who are receiving biologic therapy can benefit from safe primary prophylaxis.

AbbreviationsADAAdalimumab

BALFBronchoalveolar lavage fluid

CTComputed tomography

DASDisease Activity Score

ETNEtanercept

IFXInfliximab

ILInterleukin

MTXMethotrexate

PCPPneumocystis pneumonia

PSLPrednisolone

RARheumatoid arthritis

TCZTocilizumab

TMP-SMXTrimethoprim-sulfamethoxazole

TNFαTumor necrosis factor α.

Electronic supplementary materialThe online version of this article doi:10.1186-ar4472 contains supplementary material, which is available to authorized users.

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Author: Takayuki Katsuyama - Kazuyoshi Saito - Satoshi Kubo - Masao Nawata - Yoshiya Tanaka

Source: https://link.springer.com/



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