Opinions on <i>Pneumocystis jirovecii</i> prophylaxis in autoimmune neuromuscular disorders

Claytor, Benjamin; Li, Yuebing

doi:10.1002/mus.27481

Cited by 6 publications

(4 citation statements)

References 46 publications

(157 reference statements)

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“…In fact, several recent articles analyzing the risk of infection and PJP in neuromuscular patients suggest a very low risk, questioning the need for routine PJP prophylaxis in neuromuscular patients. 4,27,28 Therefore, there may be skepticism as to the validity and applicability of infectious disease recommendations to neuromuscular practice.…”

Section: Discussionmentioning

confidence: 99%

“…However, this literature does not address neurological or neuromuscular patients specifically, does not present data from randomized‐controlled trials or other high‐quality sources, and does not represent consensus guidelines through a formal process (such as Delphi). In fact, several recent articles analyzing the risk of infection and PJP in neuromuscular patients suggest a very low risk, questioning the need for routine PJP prophylaxis in neuromuscular patients 4,27,28 . Therefore, there may be skepticism as to the validity and applicability of infectious disease recommendations to neuromuscular practice.…”

Section: Discussionmentioning

confidence: 99%

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Chronic glucocorticoid management in neuromuscular disease: A survey of neuromuscular neurologists

Stepanian,

Laughlin,

Bacher

et al. 2024

Muscle and Nerve

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Introduction/AimsGlucocorticoids (GC) are first‐line therapy for many neuromuscular diseases. There is a lack of guidelines regarding the prevention and management of GC complications in the context of neuromuscular disease, introducing the potential for practice variation, that may compromise quality of care. Our aim was to evaluate the practice patterns among Canadian adult neuromuscular neurologists on the screening, management, and treatment of GC‐related complications and to identify variances in practice.MethodsA web‐based anonymous questionnaire was disseminated to 99 Canadian adult neuromuscular neurologists. Questions addressed patterns of screening, prevention, monitoring, and treatment of GC‐induced adverse events, including infection prophylaxis, vaccination, bone health, hyperglycemia, and other complications.ResultsSeventy‐one percent completed the survey. Of those, 52% perform screening blood work prior to initiating GC, 56% screen for infections, and 18% for osteoporosis. The majority monitor glycemic control and blood pressure (>85%). Thirty‐two (46%) reported that they do not primarily monitor GC complications, but rather provide recommendations to the primary care physician. Pneumocystis jiroveci pneumonia prophylaxis was never used by 29%, and 29% recommend vaccinations prior to GC initiation. Calcium supplementation was recommended by 80% to prevent osteoporosis. Only 36% were aware of any existing guidelines for preventing GC complications, and 91% endorsed a need for neurology‐specific guidelines.DiscussionThere is substantial variability in the management of GC adverse effects among neuromuscular neurologists, often not corresponding to limited published literature. Our results support the need for improved education and neurology‐specific guidelines to help standardize practice and improve and prevent complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chronic glucocorticoid management in neuromuscular disease: A survey of neuromuscular neurologists

Stepanian,

Laughlin,

Bacher

et al. 2024

Muscle and Nerve

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“…However, the daily dose and duration of glucocorticoid used in patients predisposing to PJP remain unknown. Some report [29] showed that steroid doses are insu cient for PJP risk strati cation and identi cation of prophylactic needs in autoimmune neuromuscular disorders.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Pneumocystis jirovecii Pneumonia in non-HIV Immunocompromised Patients and Co-pathogens Analysis by Metagenomic Next-Generation Sequencing

Huang

et al. 2022

Preprint

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Background: Pneumocystis jirovecii pneumonia (PJP) is one of the most common opportunistic infections in immunocompromised patients. However, the accurate prediction of the development of PJP in non-HIV immunocompromised patients is still unclear. Methods: Non-HIV immunocompromised patients confirmed diagnosis of PJP by the clinical symptoms, chest computed tomography and etiological results of metagenomic next-generation sequencing (mNGS) were enrolled as observation group. Another group of matched non-HIV immunocompromised patients with non-PJP pneumonia were enrolled to control group. The risk factors for the development of PJP and the co-pathogens in the bronchoalveolar lavage fluid (BALF) detected by mNGS were analyzed. Results: A total of 67 (33 PJP, 34 non-PJP) participants were enrolled from Fujian Provincial Hospital. The ages, males and underlying illnesses were not significantly different between the two groups. Compared to non-PJP patients, PJP patients were more tends to have the symptoms of fever and dyspnea. The LYM and ALB were significantly lower in PJP patients than in non-PJP patients. Conversely, LDH and serum BDG in PJP patients were significantly higher than in non-PJP controls. For immunological indicators, the levels of immunoglobulin A, G, M and complement C3, C4, the numbers of T, B, and NK cells, had no statistical difference between these two groups. Logistic multivariate analysis showed that concomitant use of corticosteroids and immunosuppressant (OR 14.146, P=0.004) and the lymphocyte counts < 0.7×109/L (OR 6.882, P=0.011) were risk factors for the development of PJP in non-HIV immunocompromised patients. 81.82% (27/33) and 64.71% (22/34) mixed infections were identified by mNGS in the PJP group and non-PJP group separately. CMV, EBV and Candida were the leading co-pathogens in PJP patients. The case numbers of CMV and EBV identified by mNGS in PJP group were significantly higher than that in the control group(p<0.005). Conclusions: Clinicians should pay close attention to the development of PJP in non-HIV immunocompromised patients who possess the risk factors of concomitant use of corticosteroids and immunosuppressant and the lymphocyte counts < 0.7×109/L. Prophylaxis for PJP cannot rely solely on CD4+ T counts in non-HIV immunocompromised patients. Whether CMV infection increases the risk of PJP remains to be further investigated.

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“…Long‐term immunosuppression is a risk factor for Pneumocystis jirovecii pneumonia (PJP), although the risk of PJP specifically in patients with IMNM is not well known. We generally follow the guidelines for patients with autoimmune neuromuscular diseases and prescribe PJP prophylaxis in patients who are on long‐term high‐dose corticosteroids or corticosteroids with other immunosuppressive agents and additionally have comorbidities that increase the risk of PJP (e.g., active cancer, lymphopenia, low CD4 count, interstitial lung disease, severe organ dysfunction) 46 . Trimethoprim‐sulfamethoxazole is prescribed 160–80 mg daily or double strength three times a week.…”

Section: Considerations For Patients On Long‐term Immunosuppressionmentioning

confidence: 99%

Management of immune‐mediated necrotizing myopathy

Suh,

Amato

2024

Muscle and Nerve

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The immune‐mediated necrotizing myopathies (IMNM) are autoimmune myositides clinically characterized by proximal predominant weakness and elevated creatine kinase (CK). They may be associated with autoantibodies (anti‐HMGCR, anti‐SRP), triggered by statin use (e.g., anti‐HMGCR myopathy), associated with cancer, or may be idiopathic. Immunotherapy is required to improve strength and decrease the CK level, but no therapies are currently approved by the U.S. Food and Drug Administration for the treatment of IMNM. The optimal treatment strategy for IMNM is currently unknown and wide practice variation exists in the management of this condition. However, observational studies and expert opinion suggest that certain therapies may be more effective for the different serological subtypes of IMNM. HMGCR IMNM often responds favorably to intravenous immunoglobulin (IVIG) even as monotherapy. Signal recognition peptide and seronegative IMNM typically require combination immunotherapy, most often consisting of an oral immunosuppressant, corticosteroids, and IVIG or rituximab. Patients often remain on immunotherapy for years and relapse is common during tapering of immunotherapy. Further studies are needed to guide the optimal management of these patients.

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Opinions on Pneumocystis jirovecii prophylaxis in autoimmune neuromuscular disorders

Cited by 6 publications

References 46 publications

Chronic glucocorticoid management in neuromuscular disease: A survey of neuromuscular neurologists

Chronic glucocorticoid management in neuromuscular disease: A survey of neuromuscular neurologists

Risk Factors Associated with Pneumocystis jirovecii Pneumonia in non-HIV Immunocompromised Patients and Co-pathogens Analysis by Metagenomic Next-Generation Sequencing

Management of immune‐mediated necrotizing myopathy

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