Pneumocystis jirovecii pneumonia (PJP) prophylaxis patterns among patients with rheumatic diseases receiving high-risk immunosuppressant drugs

Schmajuk, Gabriela; Jafri, Kashif; Evans, Michael; Shiboski, Stephen; Gianfrancesco, Milena; Izadi, Zara; Patterson, Susan; Aggarwal, Ishita; Sarkar, Urmimala; Dudley, R. Adams; Yazdany, Jinoos

doi:10.1016/j.semarthrit.2018.10.018

Cited by 46 publications

(36 citation statements)

References 25 publications

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“…Finally, prophylaxis with trimethoprim/sulfamethoxazole or pentamidine aerosol could be evaluated to prevent P. jirovecii pneumonia 100 while antivirals could be proposed for the prophylaxis of herpesvirus infections. 101 In addition, hepatitis B virus prophylaxis, associated with repeated HBV-DNA monitoring, is recommended to prevent hepatitis reactivation in HBV carriers treated with RTX.…”

Section: Safetymentioning

confidence: 99%

Efficacy and safety of rituximab in the treatment of connective tissue disease-related interstitial lung disease

Vacchi¹,

Manfredi²,

Cassone³

et al. 2021

DIC

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Section: Safetymentioning

confidence: 99%

Efficacy and safety of rituximab in the treatment of connective tissue disease-related interstitial lung disease

Vacchi¹,

Manfredi²,

Cassone³

et al. 2021

DIC

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“…We engaged in a discussion around the preventability of PJP, the potentially low prevalence among SLE patients, and concerns about adverse effects from prophylactic antibiotics. Some prior literature suggests SLE flare risk as well as increased cutaneous reactions associated with sulfonamides (30)(31)(32). Consensus was reached to include the condition in the final list with the caveat that the decision regarding PJP prophylaxis should be made on a case-by-case basis and in the setting of moderate-to-high doses of glucocorticoids.…”

Section: Resultsmentioning

confidence: 99%

Development of a Set of Lupus‐Specific, Ambulatory Care–Sensitive, Potentially Preventable Adverse Conditions: A Delphi Consensus Study

Feldman

Speyer

Ashby

et al. 2020

Arthritis Care & Research

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Objective. Individuals with systemic lupus erythematosus (SLE) are at high risk for infections and SLE-and medication-related complications. The present study was undertaken to define a set of SLE-specific adverse outcomes that could be prevented, or their complications minimized, if timely, effective ambulatory care had been received. Methods. We used a modified Delphi process beginning with a literature review and key informant interviews to select initial SLE-specific potentially preventable conditions. We assembled a panel of 16 nationally recognized USbased experts from 8 subspecialties. Guided by the RAND-UCLA Appropriateness Method, we held 2 survey rounds with controlled feedback and an interactive webinar to reach consensus regarding preventability and importance on a population level for a set of SLE-specific adverse conditions. In a final round, the panelists endorsed the potentially preventable conditions. Results. Thirty-five potential conditions were initially proposed; 62 conditions were ultimately considered during the Delphi process. The response rate was 100% for both survey rounds, 88% for the webinar, and 94% for final approval. The 25 SLE-specific conditions meeting consensus as potentially preventable and important on a population level fell into 4 categories: vaccine-preventable illnesses (6 conditions), medication-related complications (8 conditions), reproductive health-related complications (6 conditions), and SLE-related complications (5 conditions). Conclusion. We reached consensus on a diverse set of adverse outcomes relevant to SLE patients that may be preventable if patients receive high-quality ambulatory care. This set of outcomes may be studied at the health system level to determine how to best allocate resources and improve quality to reduce avoidable outcomes and disparities among those at highest risk.

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“…It is very important to take measures to deal with such a dangerous disease, in which prophylaxis against PJP may be a good method. [20] It is proved that prophylaxis against PJP for rheumatic patients can signi cantly reduce the incidence of PJP without severe adverse event. [21] The prophylaxis rate was only 4%(n = 19) patients at admission in our IIM cohort, and merely 43(9.3%) patients had taken continuous anti-PJP prophylaxis since the treatment for IIM in our hospital.…”

Section: Discussionmentioning

confidence: 99%

High Incidence and Mortality of Pneumocystis Jiroveci Infection in Anti-MDA5-Antibody Positive Dermatomyositis: Experience From a Single Center

Huang

Yan

et al. 2021

Preprint

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Background Idiopathic inflammatory myopathies (IIM) was associated with a significantly higher risk of opportunistic infections that including Pneumocystis jiroveci pneumonia (PJP), a potentially fatal opportunistic infection. However, no prior studies have evaluated the PJP infection in subtypes of IIM. Objectives To investigate the incidence rate and mortality rate of PJP infection in subgroups of Idiopathic inflammatory myopathies (IIM) patients according to myopathy specific antibodies. Methods In the first part, 463 consecutive patients with IIM were prospectively followed up for a period of at least one year to analyze incidence of PJP. In the next part, we enrolled 30 consecutive PJP patients with any rheumatic disease were to identify the mortality rate and risk factors by Cox regression. Kaplan-Meier curve with log-rank test was used to access differences in survival. Results We found that the incidence rate of PJP in IIM patients is 3.0/100 person-year, while in MDA5+DM patients is 7.5/100 person-year and in MDA5−IIM patients is 0.7/100 person-year. (P < 0.05). PJP typically happened in the first two months for MDA5 + DM patients who have a significant decrease in the CD4+ T cell counts and Lymphocyte counts (P < 0.05). In PJP + patients, the mortality was lethally higher in MDA5+DM patients than those with other rheumatic diseases (83.3% VS. 38.9%, P < 0.05). Unlike patients with other rheumatic diseases, MDA5 + patients seemed not to benefit from prompt anti-PJP treatment. For patients with other rheumatic diseases, anti-PJP treatment within 6 days was confirmed to crucially increased the survival (P < 0.05). Conclusion PJP has alarming high incidence and mortality in MDA5+DM patients. Timely treatment for PJP does not improve the prognosis of this particular subtype. Therefore, the necessity of further study of PJP prophylaxis treatment in MDA5+DM patients is verified.

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Pneumocystis jirovecii pneumonia (PJP) prophylaxis patterns among patients with rheumatic diseases receiving high-risk immunosuppressant drugs

Cited by 46 publications

References 25 publications

Efficacy and safety of rituximab in the treatment of connective tissue disease-related interstitial lung disease

Efficacy and safety of rituximab in the treatment of connective tissue disease-related interstitial lung disease

Development of a Set of Lupus‐Specific, Ambulatory Care–Sensitive, Potentially Preventable Adverse Conditions: A Delphi Consensus Study

High Incidence and Mortality of Pneumocystis Jiroveci Infection in Anti-MDA5-Antibody Positive Dermatomyositis: Experience From a Single Center

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