PMID- 37643919
OWN - NLM
STAT- MEDLINE
DCOM- 20240201
LR  - 20240206
IS  - 2151-4658 (Electronic)
IS  - 2151-464X (Print)
IS  - 2151-464X (Linking)
VI  - 76
IP  - 2
DP  - 2024 Feb
TI  - Incidence of Pneumocystis Jiroveci Pneumonia in Patients With ANCA-Associated 
      Vasculitis Initiating Therapy With Rituximab or Cyclophosphamide.
PG  - 288-294
LID - 10.1002/acr.25222 [doi]
AB  - OBJECTIVE: This manuscript assesses the incidence of Pneumocystis jiroveci 
      pneumonia (PJP) among patients receiving contemporary treatment regimens for 
      antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and adverse 
      events associated with PJP prophylaxis. METHODS: Incident users of rituximab or 
      cyclophosphamide for AAV were identified in the TriNetX electronic health records 
      database from 2011 to 2022. The incidence rates (IRs) of PJP in the first 6 
      months of induction therapy with rituximab and/or cyclophosphamide and during 
      postinduction maintenance therapy with rituximab were calculated. Cox 
      proportional hazard models were used to estimate hazard ratios (HRs) and 
      confidence intervals (CIs) for the risk of adverse events commonly associated 
      with PJP prophylaxis. RESULTS: We identified 1,461 AAV cases who received 
      induction therapy with rituximab (69.7%), cyclophosphamide (18.9%), or both 
      (11.4%). Prophylaxis prescribed within 30 days of induction included 
      trimethoprim-sulfamethoxazole (30.7%), atovaquone (5.4%), dapsone (3.8%), and 
      pentamidine (0.8%). During induction therapy, 10 cases of PJP were identified (IR 
      15.0 cases per 1,000 patient-years); no deaths occurred. In adjusted analyses, 
      those who received prophylaxis had a higher risk of leukopenia (HR 3.1; 95% CI 
      1.1-8.6), rash (HR 1.9; 95% CI 1.0-3.6), and nephropathy (HR 2.6; 95% CI 1.3-5.1) 
      than those who did not. During rituximab maintenance therapy (n = 709), five 
      cases of PJP were identified (IR 2.1 cases per 1,000 person-years), one of whom 
      died during the hospitalization associated with a PJP diagnosis. CONCLUSION: 
      Rates of PJP in patients with AAV were lower than previously observed, and few 
      cases occurred during rituximab maintenance therapy. PJP prophylaxis was 
      associated with adverse events.
CI  - (c) 2023 American College of Rheumatology.
FAU - Nettleton, Elizabeth
AU  - Nettleton E
AUID- ORCID: 0009-0009-5737-295X
AD  - Medical College of Wisconsin, Milwaukee, Wisconsin.
FAU - Sattui, Sebastian E
AU  - Sattui SE
AUID- ORCID: 0000-0002-3945-6828
AD  - University of Pittsburgh School of Medicine and University of Pittsburgh Medical 
      Center, Pittsburgh, Pennsylvania.
FAU - Wallace, Zachary
AU  - Wallace Z
AD  - Harvard Medical School, Boston, Massachusetts.
FAU - Putman, Michael
AU  - Putman M
AD  - Medical College of Wisconsin, Milwaukee, Wisconsin.
LA  - eng
GR  - L30 AR070520/AR/NIAMS NIH HHS/United States
GR  - K23 AR073334/AR/NIAMS NIH HHS/United States
GR  - R03 AR078938/AR/NIAMS NIH HHS/United States
PT  - Journal Article
DEP - 20231028
PL  - United States
TA  - Arthritis Care Res (Hoboken)
JT  - Arthritis care & research
JID - 101518086
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 8N3DW7272P (Cyclophosphamide)
SB  - IM
MH  - Humans
MH  - Rituximab/adverse effects
MH  - *Pneumocystis carinii
MH  - Incidence
MH  - *Pneumonia, Pneumocystis/chemically induced/diagnosis/epidemiology
MH  - Cyclophosphamide/therapeutic use
MH  - *Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis/drug 
      therapy/epidemiology
PMC - PMC10841679
MID - NIHMS1937613
COIS- Competing Interests: 1. None 2. Sebastian E. Sattui received research funding 
      related to clinical trials by AstraZeneca (MANDARA) and consulting from Sanofi. 
      3. Zachary Wallace reports research support from Bristol-Myers Squibb and 
      Principia/Sanofi; consulting fees from Zenas Biopharma, Visterra/Otsuka, Horizon, 
      Sanofi, Shionogi, Viela Bio, Novartis, and MedPace. 4. Michael Putman received 
      research funding related to clinical trials by Abbvie (SELECT-GCA) and 
      AstraZeneca (MANDARA) and consulting from Novaritis.
EDAT- 2023/08/30 00:41
MHDA- 2024/02/01 06:42
PMCR- 2025/02/01
CRDT- 2023/08/29 21:42
PHST- 2023/07/28 00:00 [revised]
PHST- 2023/04/08 00:00 [received]
PHST- 2023/08/24 00:00 [accepted]
PHST- 2025/02/01 00:00 [pmc-release]
PHST- 2024/02/01 06:42 [medline]
PHST- 2023/08/30 00:41 [pubmed]
PHST- 2023/08/29 21:42 [entrez]
AID - 10.1002/acr.25222 [doi]
PST - ppublish
SO  - Arthritis Care Res (Hoboken). 2024 Feb;76(2):288-294. doi: 10.1002/acr.25222. 
      Epub 2023 Oct 28.