Effectiveness and safety of lower dose sulfamethoxazole/trimethoprim for Pneumocystis jirovecii pneumonia prophylaxis in patients with systemic rheumatic diseases receiving moderate-to high-dose glucocorticoids

IF 2.4 Q2 RESPIRATORY SYSTEM Respiratory investigation Pub Date : 2024-10-22 DOI:10.1016/j.resinv.2024.10.007
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Abstract

Objectives

To compare the effectiveness and safety of low-dose sulfamethoxazole/trimethoprim (SMX/TMP) for Pneumocystis jirovecii pneumonia (PCP) prophylaxis in patients with systemic rheumatic disease (SRD) who were receiving glucocorticoids.

Methods

We retrospectively analyzed data obtained from Japanese patients with SRD who received glucocorticoids between January 2006 and April 2024. Patients were divided into two groups based on the initial dose of SMX/TMP: low-dose (one tablet twice weekly on non-consecutive days); conventional-dose (one tablet per day). The primary endpoint was the incidence of PCP after 1 year since the initiation of SMX/TMP. Secondary endpoints were discontinuation rates of SMX/TMP therapy and severe adverse drug reactions (ADRs) after 1 year since the initiation of SMX/TMP in both groups, before and after adjusting for patient characteristics.

Results

A total of 186 patients were included in this study: 60 in the low-dose group and 126 in the conventional-dose group. No patients developed PCP within one year after starting SMX/TMP; however, two patients in the low-dose group required escalation of the SMX/TMP dose to the conventional dose due to subclinical PCP. In the adjusted analysis, the low-dose group had a significantly lower discontinuation rate and a lower incidence rate of severe ADRs than the conventional-dose group.

Conclusions

Lower-dose SMX/TMP therapy was as effective as conventional therapy for PCP prophylaxis and was associated with lower discontinuation rates in patients with SRD receiving glucocorticoids.
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接受中、大剂量糖皮质激素治疗的系统性风湿病患者使用低剂量磺胺甲噁唑/三甲氧苄嘧啶预防肺孢子菌肺炎的有效性和安全性。
研究目的比较小剂量磺胺甲噁唑/三甲氧苄啶(SMX/TMP)在接受糖皮质激素治疗的系统性风湿性疾病(SRD)患者中预防肺孢子虫肺炎(PCP)的有效性和安全性:我们对2006年1月至2024年4月期间接受糖皮质激素治疗的日本SRD患者的数据进行了回顾性分析。根据SMX/TMP的初始剂量将患者分为两组:低剂量组(每周两次,每次一片,不连续服用);常规剂量组(每天一片)。主要终点是开始服用 SMX/TMP 1 年后的 PCP 发病率。次要终点是两组患者在开始使用 SMX/TMP 1 年后的 SMX/TMP 治疗中断率和严重药物不良反应(ADRs),包括调整患者特征之前和之后:本研究共纳入186名患者:结果:这项研究共纳入了 186 名患者:低剂量组 60 人,常规剂量组 126 人。没有患者在开始使用 SMX/TMP 后一年内出现 PCP;但低剂量组中有两名患者因出现亚临床 PCP 而需要将 SMX/TMP 剂量升级到常规剂量。在调整后的分析中,低剂量组的停药率和严重不良反应发生率明显低于常规剂量组:结论:在接受糖皮质激素治疗的SRD患者中,低剂量SMX/TMP疗法与常规疗法对预防五氯苯酚同样有效,且停药率更低。
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来源期刊
Respiratory investigation
Respiratory investigation RESPIRATORY SYSTEM-
CiteScore
4.90
自引率
6.50%
发文量
114
审稿时长
64 days
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