Effectiveness and safety of lower dose sulfamethoxazole/trimethoprim therapy for Pneumocystis jirovecii pneumonia in patients with systemic rheumatic diseases: A retrospective multicenter study

Ohmura, Shin-Ichiro; Naniwa, Taio; Tamechika, Shinya; Miyamoto, Toshiaki; Shichi, Daisuke; Kazawa, N; Iwagaitsu, Shiho; Maeda, Shinji; Wada, Jun-ichi

doi:10.1016/j.jiac.2018.11.014

Cited by 13 publications

(27 citation statements)

References 24 publications

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“…Third, in Table 2 the results of El‐Sadr et al 9 show that the dose of TMP/SMX apparently involved the incidence of adverse events. One study proved that there was a significant dose‐dependent increasing trend in adverse events of TMP/SMX 12 . For Japanese subjects, it may be better to reduce the dose or frequency of TMP/SMX, although we could not prove that the incidence of adverse events was related to the race or body mass index of patients.…”

Section: Discussionmentioning

confidence: 78%

“…One study proved that there was a significant dose-dependent increasing trend in adverse events of TMP/SMX. 12 For Japanese subjects, it may be better to reduce the dose or frequency of TMP/SMX, although we could not prove that the incidence of adverse events was related to the race or body mass index of patients. There are no reports that discussed whether or not we can reduce the dose of TMP/SMX safely.…”

Section: Ta B L E 1 Patient Characteristicsmentioning

confidence: 79%

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Adverse effects of trimethoprim–sulfamethoxazole for the prophylaxis of Pneumocystis pneumonia in dermatology

Kokubu

Kato

Nishikawa

et al. 2021

The Journal of Dermatology

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Pneumocystis jirovecii, and the survival rate is 52.9% for dermatology patients. 1 It develops in the background of underlying diseases, such as AIDS, malignant tumors and collagen diseases treated with highdose corticosteroids and/or immunosuppressants. Trimethoprim-sulfamethoxazole(TMP/SMX) combination has been reported to have a preventive effect against PCP. 2Dermatologists frequently administrate TMP/SMX to patients with pemphigus, pemphigoid, dermatomyositis and systemic lupus erythematosus. Because we treat these patients with corticosteroids and/or immunosuppressants for a long period of time, adverse events often occur, so we often reduce the dose of TMP/SMX due to adverse events. 3 We have managed to use TMP/SMX without causing adverse events. 4 A non-blind randomized controlled trial is now in progress. 5 However, there are only a few reported studies on the prophylaxis of PCP in dermatology. 6 In this study, we investigated the frequency of adverse events in patients with dermatological diseases who received TMP/SMX for the prophylaxis of PCP.

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Section: Discussionmentioning

confidence: 78%

Section: Ta B L E 1 Patient Characteristicsmentioning

confidence: 79%

Adverse effects of trimethoprim–sulfamethoxazole for the prophylaxis of Pneumocystis pneumonia in dermatology

Kokubu

Kato

Nishikawa

et al. 2021

The Journal of Dermatology

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“…Twenty-five articles were excluded due to the following reasons: no full-text ( N = 09), literature reviews ( N = 04), inappropriate intervention ( N = 03), no required data ( N = 03), and non-English ( N = 06). A total of 13 articles met the inclusion criteria for final analysis [ 3 , 8 , 13 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Of the 13 selected studies, nine were retrospective cohort studies [ 8 , 13 , 25 , 26 , 27 , 28 , 29 , 30 , 34 ], two case reports [ 31 ] and two randomized controlled trial (RCT) [ 3 , 33 ].…”

Section: Resultsmentioning

confidence: 99%

Trimethoprim-Sulfamethoxazole (Bactrim) Dose Optimization in Pneumocystis jirovecii Pneumonia (PCP) Management: A Systematic Review

Haseeb

Abourehab

Almalki

et al. 2022

IJERPH

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(1) Background: Pneumocystis jirovecii pneumonia (PCP) has a substantial impact on the morbidity and mortality of patients, especially those with autoimmune disorders, thus requiring optimal dosing strategies of Trimethoprim–Sulfamethoxazole (TMP-SMX). Therefore, to ensure the safety of TMP-SMX, there is a high demand to review current evidence in PCP patients with a focus on dose optimization strategies; (2) Methods: Various databases were searched from January 2000 to December 2021 for articles in English, focusing on the dose optimization of TMP-SMX. The data were collected in a specific form with predefined inclusion and exclusion criteria. The quality of each article was evaluated using a Newcastle–Ottawa Scale (NOS) for retrospective studies, Joanna Briggs Institute (JBI) critical checklist for case reports, and Cochrane bias tool for randomized clinical trials (RCTs); (3) Results: Thirteen studies met the inclusion criteria for final analysis. Of the 13 selected studies, nine were retrospective cohort studies, two case reports, and two randomized controlled trials (RCT). Most of the studies compared the high-dose with low-dose TMP-SMX therapy for PCP. We have found that a low dose of TMP-SMX provides satisfactory outcomes while reducing the mortality rate and PCP-associated adverse events. This strategy reduces the economic burden of illness and enhances patients’ compliance to daily regimen plan; (4) Conclusion: The large-scale RCTs and cohort studies are required to improve dosing strategies to prevent initial occurrence of PCP or to prevent recurrence of PCP in immune compromised patients.

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“…The diagnosis of PCP was modified according to the previously proposed diagnostic criteria for PCP (15,19,20). Definite PCP was defined as the presence of Pneumocystis jirovecii microorganisms in the patients' respiratory samples on microscopic examination or positive results on the P. jirovecii DNA polymerase chain reaction (PCR) with respiratory samples and elevated serum 1, 3-β-D-glucan levels above the cut-off value.…”

Section: Patientsmentioning

confidence: 99%

Factors Associated with <i>Pneumocystis jirovecii</i> Pneumonia in Patients with Rheumatoid Arthritis Receiving Methotrexate: A Single-center Retrospective Study

et al. 2022

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Objective To investigate the risk factors for the development of Pneumocystis jirovecii pneumonia (PCP) in patients with rheumatoid arthritis (RA) undergoing methotrexate (MTX) therapy. Method This single-center retrospective cohort study included consecutive patients with RA who received MTX for at least one year. The study population was divided into PCP and non-PCP groups, depending on the development of PCP, and their characteristics were compared. We excluded patients who received biologic disease-modifying anti-rheumatic drugs (DMARDs), Janus kinase inhibitors, and anti-PCP drugs for prophylaxis. Results Thirteen patients developed PCP, and 333 did not develop PCP. At the initiation of MTX therapy, the PCP group had lower serum albumin levels, a higher frequency of pulmonary disease and administration of DMARDs, and received a higher dosage of prednisolone (PSL) than the non-PCP group. A multivariate Cox regression analysis revealed that the concomitant use of PSL (hazard ratio [HR] 5.50, p=0.003), other DMARDs (HR 5.98, p=0.002), and serum albumin <3.5 mg/dL (HR 4.30, p=0.01) were risk factors for the development of PCP during MTX therapy. Patients with these risk factors had a significantly higher cumulative probability of developing PCP than patients who lacked these risk factors. Conclusion Clinicians should pay close attention to patients with RA who possess risk factors for the development of PCP during MTX therapy.

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Effectiveness and safety of lower dose sulfamethoxazole/trimethoprim therapy for Pneumocystis jirovecii pneumonia in patients with systemic rheumatic diseases: A retrospective multicenter study

Cited by 13 publications

References 24 publications

Adverse effects of trimethoprim–sulfamethoxazole for the prophylaxis of Pneumocystis pneumonia in dermatology

Adverse effects of trimethoprim–sulfamethoxazole for the prophylaxis of Pneumocystis pneumonia in dermatology

Trimethoprim-Sulfamethoxazole (Bactrim) Dose Optimization in Pneumocystis jirovecii Pneumonia (PCP) Management: A Systematic Review

Factors Associated with <i>Pneumocystis jirovecii</i> Pneumonia in Patients with Rheumatoid Arthritis Receiving Methotrexate: A Single-center Retrospective Study

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