ArticleArthritis research & therapy2019
Pneumocystis pneumonia in patients with rheumatic diseases receiving prolonged, non-high-dose steroids-clinical implication of primary prophylaxis using trimethoprim-sulfamethoxazole.
Article in Arthritis research & therapy, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 3 of them syntheses that pooled it.
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Who cites it
40 citing papers in PubMed, 3 syntheses or guidelines pooled it, 81 citations in OpenAlex.
- Pooled it
- Pooled it
- Trimethoprim-Sulfamethoxazole (Bactrim) Dose Optimization inInternational journal of environmental research and public health · 2022Pooled it
- The role of trimethoprim/sulfamethoxazole in preventing opportunistic infections in systemic lupus erythematosus patients receiving low-level immunosuppressive treatment: an open-label, randomized, controlled trial.Clinical and experimental medicine · 2024Trial
- Systemic Steroid Treatment for Imatinib-Associated Severe Skin Rash in Patients with Gastrointestinal Stromal Tumor: A Phase II Study.The oncologist · 2020Trial
- Association between low-dose trimethoprim-sulfamethoxazole blood concentration and clinical outcomes in non-HIV patients with Pneumocystis jirovecii pneumonia: a retrospective cohort study.BMC infectious diseases · 2026Article
- Neurosarcoidosis in Critical Care, Internal, and Pulmonary Medicine: A Practical Approach.Seminars in respiratory and critical care medicine · 2025Review
- Article
- Article
- Clinical Factors Associated With Pneumocystis Pneumonia Despite Its Primary Prophylaxis: When to Stop Prophylaxis?Arthritis & rheumatology (Hoboken, N.J.) · 2025Observational
- Pulmonary co-infection withGerms · 2025Article
- Review
- Efficacy and Safety of Low-Dose Trimethoprim-Sulfamethoxazole (TMP-SMZ) for the Prevention ofInfection and drug resistance · 2025Article
- The Incidence, Aetiology and Clinical Course of Serious Infections Complicating Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drug Therapy in Patients with Rheumatoid Arthritis in Tropical Australia.Pathogens (Basel, Switzerland) · 2024Article
- Clinical characteristics and prognosis of interstitial lung disease in systemic juvenile idiopathic arthritis: a two-center retrospective observational cohort study.Pediatric rheumatology online journal · 2024Observational
- The characteristics and clinical course of patients with melioidosis and cancer.PLoS neglected tropical diseases · 2024Article
- A Rare Case of Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome Leading to Hemodialysis and Multiple Infections: A Case Report and Literature Review.Internal medicine (Tokyo, Japan) · 2024Review
- [Influence of underlying disease and immunosuppression on the immunocompetence in inflammatory rheumatic diseases].Zeitschrift fur Rheumatologie · 2024Review
- Disseminated nocardiosis with persistent neurological disease.BMJ case reports · 2024Article
- Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 4 countries.
Funding
Abstract
objectivesTo investigate the incidence of pneumocystis pneumonia (PCP) and its risk factors in patients with rheumatic disease receiving non-high-dose steroid treatment, along with the risks and benefits of PCP prophylaxis.
methodsThis study included 28,292 treatment episodes with prolonged (≥ 4 weeks), non-high-dose steroids (low dose [< 15 mg/day, n = 27,227] and medium dose [≥ 15 to < 30 mg/day, n = 1065], based on prednisone) over a 14-year period. Risk factors for PCP and prophylactic effect of trimethoprim-sulfamethoxazole (TMP-SMX) were investigated if the 1-year incidence rate (IR) of PCP in each dose group was > 0.1/100 person-years. Cox regression with LASSO was used for analysis.
resultsOne-year PCP IR in the low-dose group was 0.01 (95% CI 0.001-0.03)/100 person-years, and only the medium-dose group showed eligible PCP IR for further analysis. In the medium-dose group, prophylactic TMP-SMX was administered in 45 treatment episodes while other episodes involved no prophylaxis (prophylaxis group vs. control group). In 1018.0 person-years, 5 PCP cases occurred exclusively in the control group, yielding an IR of 0.5 (0.2-1.2)/100 person-years. Concomitant steroid-pulse treatment and baseline lymphopenia were the most significant risk factors for PCP. Treatment episodes with at least one of these factors (n = 173, high-risk subgroup) showed higher 1-year PCP IR (3.4 (1.1-8.0)/100 person-years), while no PCP occurred in other treatment episodes. TMP-SMX numerically reduced the risk (adjusted HR = 0.2 (0.001-2.3)) in the high-risk subgroup. The IR of adverse drug reactions (ADRs) related to TMP-SMX was 41.5 (22.3-71.6)/100 person-years, including one serious ADR. The number needed to treat with TMP-SMX to prevent one PCP in the high-risk subgroup (31 (17-226)) was lower than the number needed to harm by serious ADR (45 (15-∞)).
conclusionIncidence of PCP in patients with rheumatic diseases receiving prolonged, medium-dose steroids depends on the presence of risk factors. Prophylactic TMP-SMX may have greater benefit than potential risk in the high-risk subgroup.
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Registered trials
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