ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1567

Desensitization To Trimethoprim/Sulfamethoxazole In Systemic Lupus Erythematosus Patients : A Retrospective Cohort Study

Yasuhiro Suyama1, Mitsumasa Kishimoto1, Hiroto Nakano2, Chisun Min3, Yoichiro Haji1, Ryo Rokutanda1, Yuri Ohara1, Hisanori Shimizu1, Ken-ichi Yamaguchi4, Yukio Matsui4, Kazuo Matsui2 and Masato Okada4, 1Division of Allergy & Rheumatology, St. Luke's International Hospital, Tokyo, Japan, 2Department of Rheumatology, Kameda Medical Center, Kamogawa, Japan, 3Division of Allergy and Rheumatology, St. Luke's International Hospital, Tokyo, Japan, 4Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Systemic Lupus Erythematosus - Clinical Aspects II: Central Nervous System Manifestations, Therapeutics

Session Type: Abstract Submissions (ACR)

Background/Purpose: A high incidence of trimethoprin-sulfamethoxazole (TMP/SMX) hypersensitivity is reported in patients with systemic lupus erythematosus (SLE), and reactions are often severe. Desensitization protocol is widely used for patients who have experienced minor reactions, but is contraindicated in patients with a history of severe drug eruption or hepatitis. We evaluated the safety and efficacy of TMP/SMX desensitization in patients with SLE who had not been previously exposed to TMP/SMX. Specific autoantibody profiles were also assessed as potential risk factors for TMP/SMX hypersensitivity.

Methods: Data from 56 SLE patients who received glucocorticoids and prophylactic TMP/SMX, with or without immunosuppressive agents, from 1997 to May 2013 were retrospectively analyzed. We evaluated 32 SLE patients prescribed a standard prophylactic dose of TMP/SMX (routine care group) and the results were compared with 24 SLE patients given oral TMP/SMX desensitization prophylaxis(desensitization group). We also assessed risk factors for allergic reactions using patients’ demographic and laboratory data including specific antibody status. T-test and χ2 test were performed to analyze the data.

Results:  The incidence of TMP/SMX hypersensitivity reactions in the routine care group was 43.8% (14/32) versus 12.5% (3/24) in the desensitization group (p = 0.041). The medication was discontinued in all patients who experienced clinical hypersensitivity reactions including high fever, severe drug eruption, and hepatitis; symptoms in the desensitization group appeared milder and never required hospitalization. In the routine care group, there was a higher rate of anti-Ro/SS antibody positivity in patients who experienced hypersensitivity reactions (46.2% in patients with hypersensitivity reactions vs 5.6% in patients with no reaction; p = 0.008); no association was found with other specific antibodies. Finally, when only anti-Ro/SS-A antibody positive patients were included in the analysis, there were significantly fewer hypersensitivity reactions in the desensitization group (18.2%) than the routine care group (85.7%) (p = 0.013).

Conclusion: We confirmed the high incidence of TMP/SMX hypersensitivity in patients with SLE, especially in whom anti-Ro/SS-A antibody is present. Administration of TMP/SMX per desensitization protocol appears to be effective in decreasing the incidence and severity of hypersensitivity reactions.

Disclosure:

Y. Suyama,
None;

M. Kishimoto,
None;

H. Nakano,
None;

C. Min,
None;

Y. Haji,
None;

R. Rokutanda,
None;

Y. Ohara,
None;

H. Shimizu,
None;

K. I. Yamaguchi,
None;

Y. Matsui,
None;

K. Matsui,
None;

M. Okada,
None.

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