ArticleArthritis & rheumatology (Hoboken, N.J.)2023
Risk-Benefit Analysis of Primary Prophylaxis Against Pneumocystis Jirovecii Pneumonia in Patients With Rheumatic Diseases Receiving Rituximab.
Article in Arthritis & rheumatology (Hoboken, N.J.), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 22 citations in OpenAlex.
- The Role of Rituximab in ABO-Compatible Renal Transplantation: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials.Medicina (Kaunas, Lithuania) · 2026Pooled it
- Global trends, risk factors, and therapeutic associations of fungal pulmonary infections in lung cancer: A systematic review and meta-analysis.Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia · 2025Pooled it
- Infection prophylaxis following anti-CD20 monoclonal antibodies in childhood kidney diseases.Pediatric nephrology (Berlin, Germany) · 2026Review
- B Cells and B Cell Depletion in Autoimmunity and Atherosclerosis.Life (Basel, Switzerland) · 2026Review
- Incidence of infections in patients treated with rituximab for autoimmune disorders of hematological Interest or non-Hodgkin lymphoma.Annals of hematology · 2026Article
- Bactrim Efficacy in Preventing Infections in Glomerular Diseases Receiving Rituximab.Kidney medicine · 2026Article
- Italian recommendations for the diagnosis and treatment of myasthenia gravis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- Infections and hypogammaglobulinemia in myasthenia gravis patients receiving low-dose rituximab: a real-world cohort study.Frontiers in immunology · 2026Article
- Time-Dependent Effect of Prophylactic Trimethoprim-Sulfamethoxazole on the Incidence of Serious Infections in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Target Trial Emulation Study.Arthritis & rheumatology (Hoboken, N.J.) · 2025Observational
- Trimethoprim sulfamethoxazole prophylaxis and serious infections in granulomatosis with polyangiitis treated with rituximab.Rheumatology (Oxford, England) · 2025Article
- Outcome of Pneumocystis Jirovecii pneumonia (PcP) in post-CAR-T patients with hematological malignancies.BMC infectious diseases · 2024Article
- Infectious Disease Prophylaxis During and After Immunosuppressive Therapy.Kidney international reports · 2024Review
- Article
- Incidence of Pneumocystis Jiroveci Pneumonia in Patients With ANCA-Associated Vasculitis Initiating Therapy With Rituximab or Cyclophosphamide.Arthritis care & research · 2024Article
- PJP prophylaxis with rituximab.Nature reviews. Rheumatology · 2023Article
- Article
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo identify a specific population of patients with rheumatic diseases receiving rituximab treatment for whom the benefit from primary prophylaxis against Pneumocystis jirovecii pneumonia (PJP) outweighs the risk of adverse events (AEs).
methodsThis study included 818 patients treated with rituximab for rheumatic diseases, among whom 419 received prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) with rituximab, while the remainder did not. Differences in 1-year PJP incidence between the groups were estimated using Cox proportional hazards regression. Risk-benefit assessment was performed in subgroups stratified according to risk factors based on the number needed to treat (NNT) to prevent 1 case of PJP and the number needed to harm (NNH) due to severe AEs. Inverse probability of treatment weighting was applied to minimize the confounding by indication.
resultsDuring the 663.1 person-years, there were 11 PJP cases, with a mortality rate of 63.6%. Concomitant use of high-dose glucocorticoids (≥30 mg/day of prednisone or equivalent during 4 weeks after rituximab administration) was the most important risk factor. The PJP incidence (per 100 person-years) was 7.93 (95% confidence interval [95% CI] 2.91-17.25) in the subgroup receiving high-dose glucocorticoids compared with 0.40 (95% CI 0.01-2.25) in the subgroup without high-dose glucocorticoid use. Although prophylactic TMP/SMX significantly reduced the overall PJP incidence (HR 0.11 [95% CI 0.03-0.43]), the NNT to prevent 1 case of PJP (146) was higher than the NNH (86). In contrast, the NNT fell to 20 (95% CI 10.7-65.7) in patients receiving concomitant high-dose glucocorticoids.
conclusionThe benefit associated with primary PJP prophylaxis outweighs the risk of severe AEs in patients with rheumatic diseases receiving rituximab and concomitant high-dose glucocorticoid treatment.
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