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

Abstract

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.

Safety of synthetic and biological DMARDs: a systematic literature review informing the 2022 update of the EULAR recommendations for the management of rheumatoid arthritis

“…Another study at high RoB found a similar risk of TB with abatacept compared with other b/tsDMARDs 74. The risk of pneumonia due to Pneumocystis jirovecii was increased with methotrexate combined with other csDMARDs, compared with methotrexate alone (aHR: 5.98 (95% CI 1.91 to 18.74)) (one study at high Rob) 34. Hospitalisation due to infection by SARS-CoV-2 was more likely with non-TNFi (analysed together) compared with csDMARDs and TNFi in one study,27 and with rituximab compared with TNFi in another (both at high RoB) 28.…”

“…From a total of 2961 references (after de-duplication), 226 were selected for a full-text review and 59 observational studies fulfilled the inclusion criteria 16–74. In addition, 2 RCTs with a primary safety outcome,2 3 and 28 RCTs/LTEs from the efficacy SLR,75–102 were included (flow chart in online supplemental figure S1).…”

“…Of 59 observational studies, 51 assessed only 1 outcome,16–66 and 8 addressed ≥2 outcomes (online supplemental table S1–137). 67–74 Of 27 studies evaluating the risk of infections,27–47 67 69 71–74 23 included patients on bDMARDs,27–29 31–33 35–37 39–47 69 71–74 9 of which also patients on JAKi,27 28 30 31 42 45 69 71 72 3 only patients on csDMARDs34 38 67 and 1 patients either on tofacitinib or on csDMARDs 30. Nine studies evaluated the risk of malignancies with bDMARDs,48–53 71 73 74 and one of these also with tofacitinib 71.…”

“…Of 27 studies addressing the risk of infections, 3 compared bDMARDs/JAKi to the general population,27 44 47 8 compared bDMARDs/JAKi to csDMARDs,28 30–32 35 36 46 72 3 compared the risk across csDMARDs34 38 67 and 13 across bDMARDs/JAKi29 33 35 37 39–43 45 69 71 74 (table 1 and online supplemental tables S2–S43).…”

Pneumocystis Pneumonia in Rheumatic Diseases: Prevention Issues

“…S. I. Ohmura и соавт. [46] исследовали факторы риска развития ППн у 334 пациентов с РА, получающих МТ в качестве монотерапии или комбинации с другими БПВП не менее 1 года, в рамках моноцентрового ретроспективного когортного исследования. Ни один пациент не получал профилактическую терапию.…”