Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Trimethoprin-sulfamethoxazole (TMP/SMX) is the most effective and widely used prophylactic medication in immunocompromised patients. Some diseases are well-known to cause allergic reactions including human immunodeficiency virus (HIV) infection and systemic lupus erythematosus(SLE). As opposed to HIV infection, the allergic reactions in patients with SLE are often severe and result in discontinuation, which leaves the patients with high risk of serious, sometimes life-threatening infection. We examined the efficacy and safety of the TMP/SMX desensitization protocol in patients with SLE.
Methods: We conducted a retrospective cohort study in the two major urban and rural hospitals in Japan. The oral TMP/SMX desensitization protocol was applied among SLE patients who newly received TMP/SMX prophylaxis from 2009 to 2012 (Group A). The outcomes were compared with SLE patients who had been previously prescribed with usual dose of TMP/SMX prophylaxis for the first time from 1997 to 2012 (Group B). Firstly, we studied the incidence of allergic reactions to TMP/SMX prophylaxis in between Group A and B. Secondly, we assessed the risk factors for the allergic reactions using patient`s demographics and laboratory data including specific antibody status. T-test and χ2 test were performed to analyze these data.
Results: A total of 17 patients (2 men and 15 women, the mean age; 45.2 years old, the average dose of steroid; 160.4 mg/day of prednisone or equivalent) were enrolled for this protocol in Group A and 30 patients (3 men and 27 women, the mean age; 38.1 years old, the average dose of steroid; 26.2 mg/day of prednisone or equivalent) in Group B. Patient characteristics including sex, age, and the mean dose of steroid between groups showed no differences when compared statistically. Our analysis revealed more than half of the reduction in the incidence of allergic reactions in Group A (3/17; 17.6%) than Group B (12/30; 40%) (p = 0.114). In addition, in Group B, there was a higher positive rate of anti-SS-A/Ro antibody related to allergic reactions (83.3% in allergic reactions vs 16.7% in no allergic reactions; p = 0.019), but not with other specific antibodies. Furthermore, to compare only in SLE patients with positive anti-SS-A/Ro antibody, there were significantly fewer allergic reactions in Group A (3/13; 23.1%) than Group B (5/6; 83.3%) (p = 0.013). No patients who neither required hospitalization nor increased the dose of steroid therapy due to SLE flare related to prophylaxis were documented in both Group A and B.
Conclusion: Our findings suggested that the TMP/SMX desensitization protocol would be a simple, safe, and effective means for SLE patients to prevent allergic reactions. To our knowledge, this is the first report of attempting to desensitize allergic reactions to TMP/SMX in patients with SLE. An anti-SS-A/Ro antibody positive status might be a risk factor for allergic reactions to usual dose of TMP/SMX prophylaxis and it would also predict good candidates to initiate the desensitization protocol.
Disclosure:
Y. Suyama,
None;
M. Kishimoto,
None;
H. Nakano,
None;
K. I. Yamaguchi,
None;
H. Shimizu,
None;
R. Rokutanda,
None;
C. Min,
None;
Y. Ohara,
None;
Y. Haji,
None;
K. Matsui,
None;
A. Takeda,
None;
Y. Matsui,
None;
M. Okada,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-first-report-of-desensitization-to-trimethoprimsulfamethoxazole-in-patients-with-systemic-lupus-eryhtematosus/