Cotrimoxazole prophylaxis prevents major infective episodes in patients with systemic lupus erythematosus on immunosuppressants: A non-concurrent cohort study

Abstract

Background Prophylactic trimethoprim-sulfamethoxazole (TMP-SMX) prevents pneumocystis jirovecii infection in SLE on immunosuppression. Its role in preventing other major infections in immuno suppressed SLE patients is unknown. Methods A non-concurrent cohort study was conducted on patients of SLE fulfilling SLICC and/or ACR 1997 criteria, who received tapering dose of steroid starting with ≥0.5 mg/kg/day of prednisolone or equivalent dose of deflazacort and mycophenolate mofetil ≥1 g/day (or equivalent dose of mycophenolate sodium) at least for the preceding 1 year. Interviewing patients & documenting relevant data from hospital electronic Medical records (EMR), followed by comparison of Incidence densities of major infections between those on prophylactic Trimethoprim 160 mg + Sulfamethoxazole 800 mg and those not on it, was done by student ‘t’ test. Multivariate logistic regression was performed for independent risk of any major infection between the two groups. Results Of 228 patients, 162 did not receive TMP-SMX prophylaxis, and 66 had received. The incidence density of major infection was found to be significantly lower in TMP-SMX group (1.25 per 100 person year) as compared to those not on TMP-SMX group (11.201 per 100 person year); P < 0.001 (95% CI 0.027 – 0.449) and odds ratio of 0.03 (CI 0 – 0.24). Conclusion Cotrimoxazole prophylaxis in SLE patients on immunosuppression prevents major infections.

An Overview of the Safety, Efficiency, and Signal Pathways of Stem Cell Therapy for Systemic Lupus Erythematosus

“…Conventional therapy for SLE involves steroid and/or immunosuppressive drug treatment. However, conventional therapy is only effective in mild SLE patients, and the drugs have significant side effects over long-term use, such as infection, gastrointestinal syndrome, herpes zoster, or varicella [ 4 – 7 ]. Due to the high relapse and low survival rate of SLE, novel treatments have been investigated in recent years and some progress has been made.…”