Efficacies of atovaquone, pentamidine, and trimethoprim/sulfamethoxazole for the prevention of Pneumocystis jirovecii pneumonia in patients with connective tissue diseases

Kitazawa, Takatoshi; Seo, Kazunori; Asako, Kurumi; Kikuchi, Hirotoshi; Kono, Hajime; Ota, Yasuo

doi:10.1016/j.jiac.2019.01.005

Cited by 26 publications

(27 citation statements)

References 21 publications

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“…Maezawa 73 reported that 11% of SLE patients treated with TMP/SMX experienced adverse events and the positivity of anti‐ribonucleoprotein (RNP) antibody was a risk factor. Kitazawa et al 74 compared oral TMP/SMX with aerosolized pentamidine or oral atovaquone for PJP prophylaxis in patients with connective tissue diseases including SLE. The rates of treatment continuation with TMP‐SMX, pentamidine, and atovaquone at 1 year were 55.3%, 68.6%, and 100%, respectively.…”

Section: Resultsmentioning

confidence: 99%

Prevention of infective complications in systemic lupus erythematosus: A systematic literature review for the APLAR consensus statements

et al. 2021

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Systemic lupus erythematosus (SLE) is a more common autoimmune rheumatic disease in the Asia‐Pacific region. The prognosis of SLE remains unsatisfactory in some Asian countries because of delayed diagnosis, limited access to medications, increased complications and issues of tolerability and adherence to treatment. The Asia‐Pacific League of Associations for Rheumatology SLE special interest group has recently published a set of consensus recommendations on the management of SLE for specialists, family physicians, specialty nurses, and other healthcare professionals in the Asia‐Pacific region. This article reports a systematic literature review of the infective complications of SLE in Asia and evidence for prevention of these infections by pre‐emptive antimicrobial therapy and vaccination.

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Section: Resultsmentioning

confidence: 99%

Prevention of infective complications in systemic lupus erythematosus: A systematic literature review for the APLAR consensus statements

et al. 2021

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“…Rate of drug discontinuation. Five studies were included in the rate of drug discontinuation analysis [22,27,29,30,34]. A total of 403 patients were included in the TMP-SMZ group, and 164 patients were included in the control group (other drugs to prevent PCP).…”

Section: Plos Onementioning

confidence: 99%

“…The detailed data are shown in S4 Table . On the other hand, the included studies were excluded one by one for each outcome indicator (the incidence of PCP and the rate of drug discontinuation) to analyze the sources of heterogeneity. The results are shown in S5 Table . The heterogeneity among the studies reporting the incidence of PCP was mainly due to the study by Neofytos, and the heterogeneity among the studies reporting the drug discontinuation rate was mainly due to the study by Kitazawa [10,34].…”

Section: Publication Bias and Sensitivity Analysesmentioning

confidence: 99%

“…The sensitivity analysis suggested that age, follow-up duration and research type may not be sources of heterogeneity. We excluded the included studies one by one from the main outcome analysis and found that the heterogeneity was primarily due to the clinical trial methodology in the included literature, such as in the studies by Neofytos and Kitazawa [10,34]. The diagnosis of PCP in the study by Neofytos was entirely based on polymerase chain reaction (PCR), and one of the main limitations of that study was that the PCR cycle threshold could not be used to diagnose PCR-positive cases.…”

Section: Plos Onementioning

confidence: 99%

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Efficacy and safety of trimethoprim-sulfamethoxazole for the prevention of pneumocystis pneumonia in human immunodeficiency virus-negative immunodeficient patients: A systematic review and meta-analysis

Tang

et al. 2021

PLoS ONE

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Background Pneumocystis pneumonia (PCP) has a significant impact on the mortality of immunocompromised patients. It is not known whether the prophylactic application of trimethoprim-sulfamethoxazole (TMP-SMZ) can reduce the incidence of PCP and mortality in the human immunodeficiency virus (HIV)-negative immunodeficient population. The safety profile is also unknown. There have been few reports on this topic. The aim of this study was to systematically evaluate the efficacy and safety of the use of TMP-SMZ for the prevention of PCP in this population of patients from the perspective of evidence-based medicine. Methods A comprehensive search without restrictions on publication status or other parameters was conducted. Clinical randomized controlled trials (RCTs) or case-control trials (CCSs) of TMP-SMZ used for the prevention of PCP in HIV-negative immunocompromised populations were considered eligible. A meta-analysis was performed using the Mantel-Haenszel fixed-effects model or Mantel-Haenszel random-effects model, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and reported. Results Of the 2392 records identified, 19 studies (n = 4135 patients) were included. The efficacy analysis results indicated that the PCP incidence was lower in the TMP-SMZ group than in the control group (OR = 0.27, 95% CI (0.10, 0.77), p = 0.01); however, the rate of drug discontinuation was higher in the TMP-SMZ group than in the control group (OR = 14.31, 95% CI (4.78, 42.91), p<0.00001). In addition, there was no statistically significant difference in the rate of mortality between the two groups (OR = 0.54, 95% CI (0.21, 1.37), p = 0.19). The safety analysis results showed that the rate of adverse events (AEs) was higher in the TMP-SMZ group than in the control group (OR = 1.92, 95% CI (1.06, 3.47), p = 0.03). Conclusions TMP-SMZ has a better effect than other drugs or the placebo with regard to preventing PCP in HIV-negative immunocompromised individuals, but it may not necessarily reduce the rate of mortality, the rate of drug discontinuation or AEs. Due to the limitations of the research methodologies used, additional large-scale clinical trials and well-designed research studies are needed to identify more effective therapies for the prevention of PCP.

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“…acute interstitial nephritis with immunologically induced hypersensitivity [3, 4]. Therefore, several studies have assessed the use of atovaquone or pentamidine to prevent PJP [5, 6]. Although the results are promising, TMP-SMX is still the first-choice prophylaxis [7].…”

Section: Introductionmentioning

confidence: 99%

A Case of Pneumocystis jirovecii Pneumonia under Belatacept and Everolimus: Benefit-Risk Balance between Renal Allograft Function and Infection

Perrier

Portais

Terrec

et al. 2021

Case Rep Nephrol Dial

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Pneumocystis jirovecii pneumonia is an opportunistic disease usually prevented by trimethoprim-sulfamethoxazole. A 49-year-old HLA-sensitized male with successful late conversion from tacrolimus-based to belatacept-based immunosuppression developed P. jirovecii pneumonia for which he presented several risks factors: low lymphocyte count with no CD4+ T cells detected since 2 years, hypogammaglobulinemia, history of acute cellular rejection 3 years before, and immunosuppressive treatment (belatacept, everolimus). Because of respiratory gravity in the acute phase, the patient was given oxygen, corticosteroids, and trimethoprim-sulfamethoxazole. Thanks to the improvement of respiratory status, and because of the renal impairment, trimethoprim-sulfamethoxazole was converted to atovaquone for 21 days. Indeed, after 1 week on intensive treatment, the benefit-risk balance favored preserving renal function according to respiratory improvement status. P. jirovecii pneumonia prophylaxis for the next 6 months was monthly aerosol of pentamidine. Long-term safety studies or early/late conversion to belatacept did not report on P. jirovecii pneumonia. Four other cases of P. jirovecii pneumonia under belatacept therapy were previously described in patients having no P. jirovecii pneumonia prophylaxis. Studies on the reintroduction of P. jiroveciipneumonia prophylaxis after conversion to belatacept would be of interest. It could be useful to continue regular evaluation within the second-year post-transplantation regarding immunosuppression: T-cell subsets and immunoglobulin G levels.

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Efficacies of atovaquone, pentamidine, and trimethoprim/sulfamethoxazole for the prevention of Pneumocystis jirovecii pneumonia in patients with connective tissue diseases

Cited by 26 publications

References 21 publications

Prevention of infective complications in systemic lupus erythematosus: A systematic literature review for the APLAR consensus statements

Prevention of infective complications in systemic lupus erythematosus: A systematic literature review for the APLAR consensus statements

Efficacy and safety of trimethoprim-sulfamethoxazole for the prevention of pneumocystis pneumonia in human immunodeficiency virus-negative immunodeficient patients: A systematic review and meta-analysis

A Case of <b><i>Pneumocystis jirovecii</i></b> Pneumonia under Belatacept and Everolimus: Benefit-Risk Balance between Renal Allograft Function and Infection

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