PMID- 37096489
OWN - NLM
STAT- MEDLINE
DCOM- 20231031
LR  - 20231104
IS  - 2326-5205 (Electronic)
IS  - 2326-5191 (Linking)
VI  - 75
IP  - 11
DP  - 2023 Nov
TI  - Risk-Benefit Analysis of Primary Prophylaxis Against Pneumocystis Jirovecii 
      Pneumonia in Patients With Rheumatic Diseases Receiving Rituximab.
PG  - 2036-2044
LID - 10.1002/art.42541 [doi]
AB  - OBJECTIVE: To 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). METHODS: This study included 818 patients treated with rituximab 
      for rheumatic diseases, among whom 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 proportional hazards regression. Risk-benefit assessment was performed in 
      subgroups stratified according to risk factors based on the number needed to 
      treat (NNT) to prevent 1 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. RESULTS: During the 663.1 person-years, there were 
      11 PJP cases, with a mortality rate of 63.6%. Concomitant use of high-dose 
      glucocorticoids (>/=30 mg/day of prednisone or equivalent during 4 weeks after 
      rituximab administration) was the most important risk factor. The PJP incidence 
      (per 100 person-years) was 7.93 (95% confidence interval [95% CI] 2.91-17.25) in 
      the subgroup receiving high-dose glucocorticoids compared with 0.40 (95% CI 
      0.01-2.25) in the subgroup without high-dose glucocorticoid use. Although 
      prophylactic TMP/SMX significantly reduced the overall PJP incidence (HR 0.11 
      [95% CI 0.03-0.43]), the NNT to prevent 1 case of PJP (146) was higher than the 
      NNH (86). In contrast, the NNT fell to 20 (95% CI 10.7-65.7) in patients 
      receiving concomitant high-dose glucocorticoids. CONCLUSION: The benefit 
      associated with primary PJP prophylaxis outweighs the risk of severe AEs in 
      patients with rheumatic diseases receiving rituximab and concomitant high-dose 
      glucocorticoid treatment.
CI  - (c) 2023 American College of Rheumatology.
FAU - Park, Jun Won
AU  - Park JW
AUID- ORCID: 0000-0002-8624-2582
AD  - Division of Rheumatology, Department of Internal Medicine, Seoul National 
      University College of Medicine, Seoul, Republic of Korea.
FAU - Curtis, Jeffrey R
AU  - Curtis JR
AUID- ORCID: 0000-0002-8907-8976
AD  - Division of Clinical Immunology & Rheumatology, University of Alabama at 
      Birmingham.
FAU - Choi, Se Rim
AU  - Choi SR
AD  - Division of Rheumatology, Department of Internal Medicine, Seoul National 
      University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
FAU - Kim, Min Jung
AU  - Kim MJ
AD  - Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan 
      Government-Seoul National University, Boramae Medical Center, Seoul, Republic of 
      Korea.
FAU - Ha, You-Jung
AU  - Ha YJ
AD  - Division of Rheumatology, Department of Internal Medicine, Seoul National 
      University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
FAU - Kang, Eun Ha
AU  - Kang EH
AUID- ORCID: 0000-0001-9697-1159
AD  - Division of Rheumatology, Department of Internal Medicine, Seoul National 
      University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
FAU - Lee, Yun Jong
AU  - Lee YJ
AUID- ORCID: 0000-0001-7615-8611
AD  - Division of Rheumatology, Department of Internal Medicine, Seoul National 
      University College of Medicine, Seoul, and Division of Rheumatology, Department 
      of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, 
      Gyeonggi-do, Republic of Korea.
FAU - Lee, Eun Bong
AU  - Lee EB
AUID- ORCID: 0000-0003-0703-1208
AD  - Division of Rheumatology, Department of Internal Medicine, Seoul National 
      University College of Medicine, Seoul, and Department of Molecular Medicine and 
      Biopharmaceutical Sciences, Graduate School of Convergence Science and 
      Technology, Seoul National University, Seoul, Republic of Korea.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20230822
PL  - United States
TA  - Arthritis Rheumatol
JT  - Arthritis & rheumatology (Hoboken, N.J.)
JID - 101623795
RN  - 8064-90-2 (Trimethoprim, Sulfamethoxazole Drug Combination)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 0 (Glucocorticoids)
SB  - IM
CIN - Arthritis Rheumatol. 2023 Nov;75(11):1904-1906. PMID: 37192270
MH  - Humans
MH  - *Pneumonia, Pneumocystis/epidemiology/prevention & control/etiology
MH  - Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
MH  - Rituximab/adverse effects
MH  - Glucocorticoids/therapeutic use
MH  - *Rheumatic Diseases/complications/drug therapy/chemically induced
MH  - Retrospective Studies
EDAT- 2023/04/25 06:42
MHDA- 2023/10/31 06:42
CRDT- 2023/04/25 04:23
PHST- 2023/03/31 00:00 [revised]
PHST- 2022/10/24 00:00 [received]
PHST- 2023/04/20 00:00 [accepted]
PHST- 2023/10/31 06:42 [medline]
PHST- 2023/04/25 06:42 [pubmed]
PHST- 2023/04/25 04:23 [entrez]
AID - 10.1002/art.42541 [doi]
PST - ppublish
SO  - Arthritis Rheumatol. 2023 Nov;75(11):2036-2044. doi: 10.1002/art.42541. Epub 2023 
      Aug 22.