The efficacy and safety of reduced-dose sulfamethoxazole-trimethoprim for chemoprophylaxis of<i>Pneumocystis</i>pneumonia in patients with rheumatic diseases

Harada, Tomoya; Kato, Ryohei; Sueda, Yuriko; Funaki, Yoshihiro; Takata, Miyako; Okazaki, Ryo; Hasegawa, Yasuyuki; Yamasaki, Akira

doi:10.1080/14397595.2020.1812834

Cited by 10 publications

(7 citation statements)

References 27 publications

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“…The most commonly used prophylaxis scheme is trimethoprim/sulfamethoxazole (TMP-SMX) 480 mg/day (single-strength) or 960 mg three times a week; of note, there is some evidence that reduced doses (eg, half-strength, daily) may also be effective and associated with fewer adverse events 191–195. It should be noted that adverse events related to TMP-SMX (eg, nausea, headache, rash) are common, affecting about 20% of patients 196.…”

Section: Resultsmentioning

confidence: 99%

“…[4][5][6] The most commonly used prophylaxis scheme is trimethoprim/ sulfamethoxazole (TMP-SMX) 480 mg/day (single-strength) or 960 mg three times a week; of note, there is some evidence that reduced doses (eg, half-strength, daily) may also be effective and associated with fewer adverse events . [191][192][193][194][195] It should be noted that adverse events related to TMP-SMX (eg, nausea, headache, rash) are common, affecting about 20% of patients. 196 Concerns for higher adverse event rates have been expressed for individuals treated with methotrexate (in specific relation to the combination of TMP and MTX and the risk of cytopenia) or in patients with systemic lupus erythematosus (SLE).…”

Section: Recommendationmentioning

confidence: 99%

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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%

Section: Recommendationmentioning

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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“…To establish an accurate indication for PJP prophylaxis, the safety of TMP/SMX, as well as its efficacy, needs to be thoroughly considered. Although previous studies reported cases of AEs caused by TMP/SMX, most of these studies did not assess AEs in a control group not receiving prophylaxis (25)(26)(27). Since assessing causality by reviewing medical records could be inaccurate, safety profiles of TMP/SMX that are extrapolated from ADRs could be biased.…”

Section: Discussionmentioning

confidence: 99%

Risk–Benefit Analysis of Primary Prophylaxis Against Pneumocystis Jirovecii Pneumonia in Patients With Rheumatic Diseases Receiving Rituximab

Park

Curtis

Choi

et al. 2023

Arthritis & Rheumatology

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ObjectiveTo identify a specific population of patients with rheumatic diseases receiving rituximab treatment for whom the benefit from primary prophylaxis against Pneumocystis jirovecii pneumonia (PJP) outweighs the risk of adverse events (AEs)MethodsThis study included 818 patients treated with rituximab for rheumatic diseases. Of these, 419 received prophylactic trimethoprim‐sulfamethoxazole (TMP‐SMX) with rituximab while the remainder did not. Differences in 1‐year PJP incidence between the groups were estimated using Cox regression. Risk‐benefit assessment was performed in the subgroup stratified according to risk factors based on the number needed to treat (NNT) to prevent one case of PJP and the number needed to harm (NNH) due to severe AEs. Inverse probability of treatment weighting was applied to minimize the confounding by indication.ResultsDuring the 663.1 person‐years, there were 11 PJP cases, with a mortality rate of 63.6%. Concomitant use of high‐dose glucocorticoids (≥30mg/day of prednisone during 4 weeks after rituximab administration) was the most important risk factor. The PJP incidence (per 100 person‐years) was 7.93 (2.91–17.25) in the subgroup receiving high‐dose glucocorticoids, compared with 0.40 (0.01–2.25) in the subgroup without high‐dose glucocorticoids. Although prophylactic TMP‐SMX significantly reduced the overall PJP incidence (HR 0.11 [0.03–0.37]), the NNT to prevent one PJP was higher than the NNH (146 vs. 86). In contrast, the NNT fell to 20 (10.7–65.7) in patients receiving concomitant high‐dose glucocorticoids.ConclusionThe benefit associated with primary PJP prophylaxis overweighs the risk of severe AEs in patients receiving rituximab and concomitant high‐dose glucocorticoid treatment.This article is protected by copyright. All rights reserved.image

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“…Наиболее часто используемой схемой профилактики ППн является прием триметоприм/сульфаметоксазола (ТМП-СМК) 480 мг/сут. или 960 мг три раза в неделю [51,52]. Имеются публикации, свидетельствующие о том, что уменьшенные дозы (например, 240 мг ежедневно) также могут быть эффективными и связаны с меньшим количеством НЯ.…”

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 efficacy and safety of reduced-dose sulfamethoxazole-trimethoprim for chemoprophylaxis ofPneumocystispneumonia in patients with rheumatic diseases

Abstract: The efficacy and safety of reduced-dose sulfamethoxazole-trimethoprim for chemoprophylaxis ofPneumocystispneumonia in patients with rheumatic diseases 著者 Auther(s)

Cited by 10 publications

References 27 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

Risk–Benefit Analysis of Primary Prophylaxis Against Pneumocystis Jirovecii Pneumonia in Patients With Rheumatic Diseases Receiving Rituximab

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

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