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Pneumocystis prophylaxis may be unnecessary in autoimmune blistering diseases

One patient in a large cohort of individuals with autoimmune blistering diseases developed pneumocystis pneumonia, suggesting that routine prophylaxis of this condition may not be warranted in this patient population, according to recent findings.

The aim of the retrospective analysis was to shed further light on prophylaxis of pneumocystis pneumonia in immunocompromised patients who do not have HIV. Researchers investigated the incidence of this condition in a cohort of 801 patients with autoimmune blistering diseases who were receiving no prophylactic therapy.

Eligible participants had a confirmed diagnosis of pemphigus vulgaris/foliaceus, bullous pemphigoid, epidermolysis bullosa acquisita, mucous membrane pemphigoid/cicatricial pemphigoid, or anti-p200 pemphigoid, and were enrolled from sites in Europe, the Middle East and Asia. Diseases were confirmed by “elevated lactate dehydrogenase, or hospitalization for pneumonia with bronchioalveolar lavage demonstrating Pneumocystis jiroveci on confirmatory stains,” according to study background.

Results showed just one case of pneumocystis pneumonia in the cohort, for an incidence rate of 0.1%. This rate was significantly less than the previously recommended threshold of 3.5% for using prophylactic measures (X₁² = 27.0; P < .001). In addition, researchers reported that the incidence rate of pneumocystis pneumonia was significantly lower than the previously reported rate of the condition among patients receiving immunosuppressive therapies for dermatologic conditions (X₁² = 8.2; P = .004).

The researchers wrote that preventive therapies for pneumocystis pneumonia include trimethoprim-sulfamethoxazole, atovaquone (Mepron, GlaxoSmithKline), dapsone (Aczone, Allergan) and pentamide.

“Patients with autoimmune blistering disease seem to have a lower risk of [pneumocystis pneumonia] than the general population of immunosuppressed dermatology patients,” the researchers concluded. “Risks of routine prophylaxis include hyperkalemia, hypoglycemia, photosensitivity, thrombocytopenia and more rare adverse reactions.” – by Rob Volansky

Disclosure: The authors report no relevant financial disclosures.