Session Type: Poster Session (Tuesday)
Session Time: 9:00AM-11:00AM
Background/Purpose: Trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as a first-line agent of pneumocystis pneumonia (PCP) prophylaxis for those who receive prolonged high-dose glucocorticoids. Alternative agents can be used, but relative efficacy of PCP prophylactic regimens are unknown. We investigated the prophylactic effect of TMP-SMX and other agents for PCP in patients with connective tissue diseases (CTDs) receiving high-dose glucocorticoids.
Methods: Patients with CTDs aged ≧ 18 years who were treated with a prolonged course (≧ 4 weeks) of steroids (≧ 20 mg/day prednisone) in a Japanese tertiary center between January 2013 and December 2017 were included. The patients were categorized into three groups; TMP-SMX, other prophylactic drugs (atovaquone or aerosolized pentamidine), and no prophylaxis group. One-year incidence rate of PCP among the three groups was compared using a cox proportional hazards model.
Results: A total of 480 patients were identified. Two hundred ninety six patients received TMP-SMX while 115 received other prophylactic drugs (107 atovaquone and 8 aerosolized pentamidine). Compared with the no prophylaxis group, patients in the TMP-SMX and other prophylactic drugs group were older, more likely to have chronic lung disease and to be treated with cyclophosphamide and higher dose of glucocorticoids. During a total of 418.95 patient-years, 11 PCP cases (2 in the TMP-SMX, 6 in other prophylactic drugs, and 3 in the no prophylaxis group) occurred with a mortality rate of 54.5%. As compared with no prophylaxis, TMP-SMX significantly reduced the PCP incidence (adjusted HR=0.009, 95%CI 0.0005 to 0.15, p< 0.01) while other prophylactic drugs also reduced the PCP incidence (adjusted HR=0.034, 95%CI: 0.003-0.47, p=0.01).
Conclusion: Not only TMP-SMX but other PCP prophylactic drugs, atovaquone and aerosolized pentamidine, significantly reduced the PCP incidence in CTDs patients receiving prolonged high dose glucocorticoids. TMP-SMX seems to be more effective as a primary prophylaxis against PCP than other prophylactic drugs.
To cite this abstract in AMA style:Akashi K, Jinno S, Onishi A, Yamashita M, Nose Y, Okano T, Ueda Y, Sendo S, Saegusa J, Morinobu A. The Comparative Efficacy of Pneumocystis Pneumonia Prophylactic Regimens in Patients with Connective Tissue Diseases Receiving Prolonged High-dose Glucocorticoids [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/the-comparative-efficacy-of-pneumocystis-pneumonia-prophylactic-regimens-in-patients-with-connective-tissue-diseases-receiving-prolonged-high-dose-glucocorticoids/. Accessed February 27, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-comparative-efficacy-of-pneumocystis-pneumonia-prophylactic-regimens-in-patients-with-connective-tissue-diseases-receiving-prolonged-high-dose-glucocorticoids/