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Prophylaxis reduced risk for pneumocystis pneumonia among RA patients on biologics
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Patients with rheumatoid arthritis who were receiving biologic therapy and had risk factors for developing pneumocystis pneumonia reduced their risk when treated with trimethoprim-sulfamethoxazole prophylaxis in a recent study.
Researchers in Japan conducted a retrospective analysis of 702 patients with rheumatoid arthritis (RA; mean age, 58 years; 82.3% women) who started biologics between April 2005 and September 2009. Risk factors for pneumocystis pneumonia (PCP) were determined by comparing characteristics between patients with and without PCP. There were 141 patients (20.1%) who received 80 mg trimethoprim and 400 mg sulfamethoxazole (TMP-SMX) prophylaxis daily.
The researchers also studied 214 patients (mean age, 58.9 years; 81.3% women) with RA who began biologic treatment between October 2009 and September 2010. Ninety-four patients (43.9%) received prophylaxis against PCP, including TMP-SMX (n=82).
PCP developed in nine patients (1.28%) in the retrospective study, none who were treated with TMP-SMX. Using logistic regression analysis, three risk factors were identified for PCP: aged 65 years or older (HR=4.37; 95% CI, 1.04-18.2), coexisting pulmonary disease (HR=8.13; 95% CI, 1.63-40) and glucocorticoid use (HR=11.4; 95% CI, 1.38-90.9).
“We defined the prophylactic procedure for PCP wherein the patients with two or three risk factors would be given prophylaxis,” the researchers said, noting that TMP-SMX did not induce any severe adverse events.
There were no cases of PCP reported in the later study, which reduced PCP incidence to 0 per 100 patient-years compared with 0.93 per 100 patient-years before the procedure.
“The results … revealed that [RA patients receiving biologics] with two or three risk factors could benefit from PCP prophylaxis using TMP-SMX,” the researchers concluded. “We also showed the prophylactic effectiveness and the safety of the inclusion criterion. However, there was not enough number of patients, and we need to continue applying this prophylactic procedure to further investigate its validity and safety.”
Disclosure: See the study for a full list of relevant financial disclosures.
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