Pneumocystis jirovecii in immunocompromised patients with rheumatic diseases

Casasempere, Paloma Vela; Torregrosa, Paloma Ruiz; Sevila, Raquel García

doi:10.1016/j.reumae.2020.02.007

Cited by 3 publications

(3 citation statements)

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“…Data specifically addressing the contribution of other antirheumatic drugs in PCP development are limited 188 189. On the other hand, it has been shown that coadministration of immunosuppressants with glucocorticoids184 185 190 increase the risk for PCP. Other features including persistent lymphopenia,5 6 184 185 older age and pre-existing lung disease are also considered risk factors for PCP 4–6…”

Section: Resultsmentioning

confidence: 99%

2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

et al. 2022

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ObjectivesTo develop EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in patients with autoimmune inflammatory rheumatic diseases (AIIRD).MethodsAn international Task Force (TF) (22 members/15 countries) formulated recommendations, supported by systematic literature review findings. Level of evidence and grade of recommendation were assigned for each recommendation. Level of agreement was provided anonymously by each TF member.ResultsFour overarching principles (OAP) and eight recommendations were developed. The OAPs highlight the need for infections to be discussed with patients and with other medical specialties, in accordance with national regulations. In addition to biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARDs) for which screening for latent tuberculosis (TB) should be performed, screening could be considered also before conventional synthetic DMARDs, glucocorticoids and immunosuppressants. Interferon gamma release assay should be preferred over tuberculin skin test, where available. Hepatitis B (HBV) antiviral treatment should be guided by HBV status defined prior to starting antirheumatic drugs. All patients positive for hepatitis-C-RNA should be referred for antiviral treatment. Also, patients who are non-immune to varicella zoster virus should be informed about the availability of postexposure prophylaxis should they have contact with this pathogen. Prophylaxis againstPneumocystis jiroveciiseems to be beneficial in patients treated with daily doses >15–30 mg of prednisolone or equivalent for >2–4 weeks.ConclusionsThese recommendations provide guidance on the screening and prevention of chronic and opportunistic infections. Their adoption in clinical practice is recommended to standardise and optimise care to reduce the burden of opportunistic infections in people living with AIIRD.

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Section: Resultsmentioning

confidence: 99%

2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

et al. 2022

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“…Данные, касающиеся конкретного вклада других противоревматических препаратов в развитие ППн, ограничены. С другой стороны, показано, что совместное применение иммунодепрессантов с ГК увеличивает риск ППн [44,45]. В качестве факторов риска ППн также рассматриваются персистирующая лимфопения, пожилой возраст и заболевания легких в анамнезе [46,47].…”

Section: пневмоцистная пневмонияunclassified

Chronic and opportunistic infections in patients with immuno-inflammatory rheumatic diseases: screening and prevention issues (based on the materials of the EULAR recommendations)

Белов¹,

Гриднева²,

Аронова³

et al. 2023

Naučno-praktičeskaâ revmatologiâ

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At the present stage of development of rheumatology, much attention is paid to the problem of comorbid infections, which have a significant impact on mortality and mortality, especially in immuno-inflammatory rheumatic diseases (IIRD). The active introduction into clinical practice of innovative drugs, the action of which is aimed at specific components of the pathogenesis of IIRD, has led to an increase in the risk of developing infections of various nature and localization, including chronic and opportunistic (COI). This article analyzes the recommendations for screening and prevention of COI in adult patients with acute respiratory infections, proposed in November 2022 by experts of the European Alliance of Rheumatology Associations (EULAR). It is noted that these recommendations should be considered through the prism of national guidelines that take into account regional risk factors, features of the course, diagnosis, therapy and prevention of СOI. At the same time, it seems absolutely justified to periodically review screening and preventive procedures as new scientific data accumulate. Despite the importance of a multidisciplinary approach and the need for close cooperation with doctors of other specialties, the EULAR working group emphasizes the central role of a rheumatologist in the management of patients with HOI that occur against the background of IIRD and are associated with the received anti-rheumatic therapy.

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“…The 8-aminoquinolines (8-AQ) are an important class of anti-infective therapeutics for treatment, radical cure and prophylaxis of Plasmodium vivax malaria [ 1 , 2 ] and for prophylaxis as well as transmission blocking of Plasmodium falciparum [ 3 , 4 ]. The utility of 8-AQs has also been suggested for treatment of other protozoal infections [ 5 ] and also Pneumocystis pneumonia [ 6 , 7 ], an opportunistic infection in AIDS and other immuno-compromised patients [ 8 ]. Primaquine hybrid analogs have also shown promising antimycobacterial activity in experimental models [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Enantioselective Interactions of Anti-Infective 8-Aminoquinoline Therapeutics with Human Monoamine Oxidases A and B

et al. 2021

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8-Aminoquinolines (8-AQs) are an important class of anti-infective therapeutics. The monoamine oxidases (MAOs) play a key role in metabolism of 8-AQs. A major role for MAO-A in metabolism of primaquine (PQ), the prototypical 8-AQ antimalarial, has been demonstrated. These investigations were further extended to characterize the enantioselective interactions of PQ and NPC1161 (8-[(4-amino-1-methylbutyl) amino]-5-[3, 4-dichlorophenoxy]-6-methoxy-4-methylquinoline) with human MAO-A and -B. NPC1161B, the (R)-(−) enantiomer with outstanding potential for malaria radical cure, treatment of visceral leishmaniasis and pneumocystis pneumonia infections is poised for clinical development. PQ showed moderate inhibition of human MAO-A and -B. Racemic PQ and (R)-(−)-PQ both showed marginally greater (1.2- and 1.6-fold, respectively) inhibition of MAO-A as compared to MAO-B. However, (S)-(+)-PQ showed a reverse selectivity with greater inhibition of MAO-B than MAO-A. Racemic NPC1161 was a strong inhibitor of MAOs with 3.7-fold selectivity against MAO-B compared to MAO-A. The (S)-(+) enantiomer (NPC1161A) was a better inhibitor of MAO-A and -B compared to the (R)-(−) enantiomer (NPC1161B), with more than 10-fold selectivity for inhibition of MAO-B over MAO-A. The enantioselective interaction of NPC1161 and strong binding of NPC1161A with MAO-B was further confirmed by enzyme-inhibitor binding and computational docking analyses. Differential interactions of PQ and NPC1161 enantiomers with human MAOs may contribute to the enantioselective pharmacodynamics and toxicity of anti-infective 8-AQs therapeutics.

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Pneumocystis jirovecii in immunocompromised patients with rheumatic diseases

Cited by 3 publications

References 54 publications

2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

Chronic and opportunistic infections in patients with immuno-inflammatory rheumatic diseases: screening and prevention issues (based on the materials of the EULAR recommendations)

Enantioselective Interactions of Anti-Infective 8-Aminoquinoline Therapeutics with Human Monoamine Oxidases A and B

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