Prophylaxis in dermatologic patients receiving immunosuppressive therapy

Rencic, Adrienne; Caeiro, Juan Pablo; Hernández, María Inés; Nousari, Hossein C.

doi:10.1046/j.1529-8019.2002.01544.x

Cited by 4 publications

(3 citation statements)

References 39 publications

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“…All patients had also a concomitant antifungal treatment against oropharyngeal candidosis, this consisting of miconazole gel applied once or twice daily, or nystatin (4 mL qid) or fluconazole rinses (5 mL bid). To prevent corticosteroid‐induced osteoporosis, some patients needed also to take sodium clodronate 100 mg/3.3 mL injection monthly, 1000 mg of calcium carbonate and 400 IU of vitamin D daily until 2011; later, the usual prescription was of alendronic acid (70 mg weekly) and 400 IU of vitamin D daily.…”

Section: Methodsmentioning

confidence: 99%

Long‐term evaluation of pemphigus vulgaris: A retrospective consideration of 98 patients treated in an oral medicine unit in north‐west Italy

Arduino

Broccoletti

Carbone

et al. 2019

J Oral Pathology Medicine

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Background Despite the frequency of oral involvement, there are unexpectedly few studies of either on the oral manifestations of pemphigus or their long‐term management, and diagnostic delay in Dentistry is frequent. Methods We have examined outcome of patients presenting with predominantly oral pemphigus vulgaris (PV). Ninety‐eight subjects were followed up for 85.12 months and treated with systemic steroids: 48 of them received adjunctive therapy with azathioprine, 16 with rituximab, 13 with mycophenolate mofetil, three with immunoglobulin and one with dapsone. Results Clinical remission was achieved in 80 patients (84.21%); 39 of them were off therapy and 41 on therapy. Fifteen patients were not in remission, having been under systemic therapy for 72.16 months. Sixty‐nine patients developed detectable adverse effects. Two fatal outcomes were recorded. Each additional year of steroid therapy ensured 47% chance of developing 1 or 2 side effects, and 64% chance of developing more than 3 (ORs 1.47, CI 1.162‐1.903; ORs 1.64, CI 1.107‐2.130, respectively). Conclusion In one of the largest available cohort with the longest follow‐up ever reported, we observed that the management remains need‐based and patient‐specific, still relying on systemic corticosteroids.

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Section: Methodsmentioning

confidence: 99%

Long‐term evaluation of pemphigus vulgaris: A retrospective consideration of 98 patients treated in an oral medicine unit in north‐west Italy

Arduino

Broccoletti

Carbone

et al. 2019

J Oral Pathology Medicine

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show abstract

“…15,45 Our study found that acquisition of PCP is rare in patients not infected with HIV and receiving systemic immunosuppressive medications for conditions with prominent dermatologic manifestations. These findings do not support the practice of routine PCP prophylaxis in unselected adult dermatology patients who require treatment with immunosuppressive medications.…”

Section: Discussionmentioning

confidence: 76%

Role of primary prophylaxis for pneumocystis pneumonia in patients treated with systemic corticosteroids or other immunosuppressive agents for immune-mediated dermatologic conditions

Lehman

Kalaaji

2010

Journal of the American Academy of Dermatology

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“…Previous studies have also described probable risk factors contributing to PJP occurrence in patients with autoimmune and inflammatory diseases, revealing that corticosteroids, immunosuppressants, interstitial lung disease, high disease activity, lymphopenia, hypoalbuminemia, and advanced age (C 65 years) may all predispose patients to a higher risk of developing PJP [40,46,47]. Among these factors, corticosteroid use is well established [48,49]. However, there is no consensus on the threshold corticosteroid dose that warrants routine prophylaxis for PJP.…”

Section: Discussionmentioning

confidence: 99%

Cotrimoxazole as a Preventative Intervention for Pneumocystis Pneumonia in Pemphigus Patients Treated with Rituximab: A Retrospective Study

Hsu

Huang

Cho

et al. 2023

Dermatol Ther (Heidelb)

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Introduction Pneumocystis jirovecii pneumonia (PJP) is a severe, life-threatening complication in patients treated with rituximab. However, there is no consensus on the primary prophylaxis for it in rituximab-treated pemphigus patients. Therefore, we sought to investigate the prophylactic efficacy and safety profile of cotrimoxazole for reducing the risk of developing PJP in pemphigus patients receiving rituximab. Methods This single-center retrospective study investigated 148 pemphigus patients undergoing a first cycle of rituximab between 2008 and 2021 at a tertiary referral center in northern Taiwan. Patients were divided into the prophylaxis group ( N = 113) and the control group ( N = 35) according to whether or not cotrimoxazole was administered. The primary outcome was the 1-year incidence of PJP in the two groups, while the secondary outcome was the incidence of cotrimoxazole-related adverse events. Results Of the 148 patients enrolled in this study, three patients, all in the control group, developed PJP during the 1-year follow-up. The incidence of PJP (8.6%) in the control group was significantly higher than that in the prophylaxis group (0%) ( p = 0.012). The incidence of cotrimoxazole-related adverse events was 2.7%, and none of the cases were associated with life-threatening conditions. In addition, the cumulative prednisolone dose was associated with a trend of a higher risk of PJP ( p = 0.0483). Conclusions Prophylactic cotrimoxazole significantly reduces the risk of PJP in a certain high-risk population and has a tolerable safety profile.

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Prophylaxis in dermatologic patients receiving immunosuppressive therapy

Abstract: Despite substantial advances in developing more selective agents, immunosupressive therapy is still associated with serious complications. This article summarizes the preventive measures that can significantly reduce the incidence or severity of immunosupressive side effects.

Cited by 4 publications

References 39 publications

Long‐term evaluation of pemphigus vulgaris: A retrospective consideration of 98 patients treated in an oral medicine unit in north‐west Italy

Long‐term evaluation of pemphigus vulgaris: A retrospective consideration of 98 patients treated in an oral medicine unit in north‐west Italy

Role of primary prophylaxis for pneumocystis pneumonia in patients treated with systemic corticosteroids or other immunosuppressive agents for immune-mediated dermatologic conditions

Cotrimoxazole as a Preventative Intervention for Pneumocystis Pneumonia in Pemphigus Patients Treated with Rituximab: A Retrospective Study

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