Do patients on biologic drugs for rheumatic disease need PCP prophylaxis?

Tabanor, Joy-Ann; Lakshminarayanan, Santhanam

doi:10.3949/ccjm.86a.18084

Cited by 4 publications

(12 citation statements)

References 34 publications

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“…37,38 The incidence of PCP with TNF inhibitors, tocilizumab, and rituximab is also low; however, several studies have demonstrated that the risk of infection is increased in particular conditions including age >65 years, concurrent long-term corticosteroid use (e.g., ≥ 15 mg/day prednisolone for more than four weeks), and co-existence of either pulmonary diseases or underlying granulomatosis with polyangiitis. 38,39 Comparative studies have shown a greater risk with TNF inhibitors, particularly infliximab than tocilizumab. 40 Eighteen cases of ibrutinib associated PCP have been published; in most of them, the patients were neutropenic.…”

Section: Bcr-abl Tyrosine Kinase Inhibitorsmentioning

confidence: 99%

“…TNF inhibitors are not recommended in the acute phase of hepatitis B, chronic untreated hepatitis B, and HBV infected patients with Child-Pugh B and C. 86 Some experts consider PCP prophylaxis for patients with rheumatologic diseases under TNF inhibitors who have underlying pulmonary diseases or receiving ≥ 15 mg/day prednisolone for more than four weeks. 39 IL-1-targeted agents In the case of latent tuberculosis, treatment with isoniazid for nine months, rifampin for four months, or the combination of isoniazid and rifampin for three months is recommended. 8 Some experts consider PCP prophylaxis for patients with rheumatologic diseases under IL-1 targeted agents who have underlying pulmonary diseases or receiving ≥ 15 mg/day prednisolone for more than four weeks.…”

Section: The Risk Of Progressive Multifocal Leukoencephalopathy (Pml)mentioning

confidence: 99%

“…8 Some experts consider PCP prophylaxis for patients with rheumatologic diseases under IL-1 targeted agents who have underlying pulmonary diseases or receiving ≥ 15 mg/day prednisolone for more than four weeks. 39 CD22-targeted agents Antiviral treatment is recommended in HBS-Ag positive patients who are candidates for CD-22 targeted agents. 12 Monitoring of HBV viral load is recommended in HBS-Ag negative and anti-HBc-positive patients.…”

Section: The Risk Of Progressive Multifocal Leukoencephalopathy (Pml)mentioning

confidence: 99%

“…14,26 Some experts consider PCP prophylaxis for granulomatosis polyangiitis patients on rituximab and patients with rheumatologic diseases who have underlying pulmonary diseases. 39 PCP prophylaxis is optional for patients undergoing R-CHOP 14 regimen. 26 The third international consensus on CMV prophylaxis in solid organ transplant weakly recommends CMV prophylaxis in donor/recipient seropositive patients who are candidates for rituximab therapy during treatment of solid organ transplant rejection or desensitization protocol for up to 6 months.…”

Section: The Risk Of Progressive Multifocal Leukoencephalopathy (Pml)mentioning

confidence: 99%

“…30 Some experts consider PCP prophylaxis for patients with rheumatologic diseases under abatacept who have underlying pulmonary diseases or receiving ≥ 15 mg/day prednisolone for more than four weeks. 39 Agent targeting B-cell activating factor Some experts consider PCP prophylaxis for patients with rheumatologic diseases under abatacept who have underlying pulmonary diseases or receiving ≥ 15 mg/day prednisolone for more than four weeks. 39 IgE-targeted agent In the case of parasitic infections, patients should be treated with a specific antiparasitic agent prior to omalizumab administration.…”

Section: The Risk Of Progressive Multifocal Leukoencephalopathy (Pml)mentioning

confidence: 99%

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<p>Prevention Strategies to Minimize the Infection Risk Associated with Biologic and Targeted Immunomodulators</p>

Kordzadeh-Kermani

Khalili

Karimzadeh

et al. 2020

IDR

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The introduction of biologic and targeted immunomodulators is a significant breakthrough in the therapeutic area of various fields of medicine. The occurrence of serious infections, a complication of secondary immunosuppression associated with these agents, leads to increased morbidity and mortality. Implementing preventive strategies could minimize infection-related complications and improve therapeutic outcomes. The purpose of this review is to focus on current evident approaches regarding screening, monitoring, preventing (immunization and chemoprophylaxis), and management of infections in patients who are candidates for about 70 biologic and targeted immunomodulators. Recommendations are based on relevant guidelines, especially the ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document series published in 2018.

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Section: Bcr-abl Tyrosine Kinase Inhibitorsmentioning

confidence: 99%

Section: The Risk Of Progressive Multifocal Leukoencephalopathy (Pml)mentioning

confidence: 99%

Section: The Risk Of Progressive Multifocal Leukoencephalopathy (Pml)mentioning

confidence: 99%

Section: The Risk Of Progressive Multifocal Leukoencephalopathy (Pml)mentioning

confidence: 99%

Section: The Risk Of Progressive Multifocal Leukoencephalopathy (Pml)mentioning

confidence: 99%

See 3 more Smart Citations

<p>Prevention Strategies to Minimize the Infection Risk Associated with Biologic and Targeted Immunomodulators</p>

Kordzadeh-Kermani

Khalili

Karimzadeh

et al. 2020

IDR

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Epidemiology, Risk Factors, and Prophylaxis Use for Pneumocystis jirovecii Pneumonia in the Non-HIV Population: A Retrospective Study in Québec, Canada

Quigley,

d’Amours,

Gervais

et al. 2023

Open Forum Infectious Diseases

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Background Pneumocystis jirovecii pneumonia (PJP) remains a significant threat in immunocompromised patients. Recent data on epidemiology and risk factors for PJP in non-HIV patients is scarce and guidelines on appropriate prophylaxis are lacking. Methods In this multi-center, retrospective trial, all non-HIV adult patients admitted to Quebec City, Canada hospitals between January 2011 and January 2021 with a diagnosis of PJP were assessed for eligibility. Results One hundred and twenty-nine cases of PJP were included. More than two-thirds had an underlying hematologic disease or an autoimmune/inflammatory condition. 83.7% were on corticosteroids, 71.3% on immunosuppressive agents (alone or in combination with corticosteroids, while 62% received both prior to their diagnosis. A diagnosis of PJP was noted in 22 patients receiving corticosteroids for treatment during less than 28 days. Two patients developed PJP while on corticosteroids monotherapy at a mean daily prednisone-equivalent dose of < 20 mg/day. 4.7 % of our cohort received a PJP prophylaxis. Current recommendations or accepted clinical practices for PJP prophylaxis would not have applied to 48.8% of our patients. Conclusion The use of corticosteroids, in monotherapy or in co-administration with other immunosuppressive agents, remains the principal risk factor for PJP in the non-HIV population. Current prophylaxis guidelines and accepted practices are insufficient to adequately prevent Pneumocystis jirovecii pneumonias and need to be broadened and updated.

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Complications of complications: diagnosis and treatment of recurrent macrophage activation syndrome in a patient with well-controlled systemic juvenile idiopathic arthritis

Macaraeg

Schulert

2023

RMD Open

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Macrophage activation syndrome (MAS) is a subtype of haemophagocytic lymphohistiocytosis (HLH), and a well-described complication of systemic juvenile idiopathic arthritis (SJIA), triggered by disease onset or flare, infection, or some medications. Here, we report a 20-year-old man with previously well-controlled SJIA, who developed first time MAS after acute Epstein-Barr virus (EBV) infection, with MAS recurrence due to a drug reaction, ‘3-week sulfasalazine syndrome’, secondary to prophylactic trimethoprim/sulfamethoxazole. Both episodes of MAS were minimally responsive to pulse corticosteroids. Initial EBV-driven MAS was treated with multiple doses of emapalumab prior to resolution, while MAS secondary to sulfasalazine-induced 3-week syndrome required the initiation of ruxolitinib. This case exhibits two rare but life-threatening causes of MAS/secondary HLH in a single patient and the difficulties in their diagnosis and management.

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Do patients on biologic drugs for rheumatic disease need PCP prophylaxis?

Cited by 4 publications

References 34 publications

<p>Prevention Strategies to Minimize the Infection Risk Associated with Biologic and Targeted Immunomodulators</p>

<p>Prevention Strategies to Minimize the Infection Risk Associated with Biologic and Targeted Immunomodulators</p>

Epidemiology, Risk Factors, and Prophylaxis Use for Pneumocystis jirovecii Pneumonia in the Non-HIV Population: A Retrospective Study in Québec, Canada

Complications of complications: diagnosis and treatment of recurrent macrophage activation syndrome in a patient with well-controlled systemic juvenile idiopathic arthritis

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