Hydroxychloroquine may reduce risk of Pneumocystis pneumonia in lupus patients: a Nationwide, population-based case-control study

Abstract

Background: Pneumocystis pneumonia (PCP) is increasingly being diagnosed in patients with systemic lupus erythematosus (SLE), and hydroxychloroquine (HCQ) has been found to possess antifungal activities. We hence aimed to investigate the association between HCQ and PCP risk among patients with SLE. Methods: Using the 1997-2013 nationwide claim data, we identified 24,343 newly-diagnosed SLE patients. We then identified 58 PCP cases and selected 348 non-PCP controls matching (1:6) by age, sex, disease duration and the year of PCP diagnosis date. The risk of PCP was assessed by determing odds ratios (ORs) with 95% confidence intervals (CIs) by using multivariable conditional logistic regression. Results: The risk of PCP was associated with moderate to severe renal disease (OR 6.73, 95% CI 1.98-22.92), higher doses of glucocorticoids (≤5 mg/day, reference; 5-10 mg/day, OR 25.88, 95% CI 2.97-225.33; > 10 mg/day, OR 286.58, 95% CI 28.58-> 999), higher 3-month cumulative dose of cyclophosphamide (not use, reference; ≤1.4 g, OR 0.64, 95% CI 0.14-3.01; > 1.4 g, OR 11.52, 95% CI 1.97-67.39) and use of mycophenolate mofetil/mycophenolic acid (OR 50.79, 95% CI 5.32-484.77), whereas 3-month cumulative dose of HCQ was associated with a reduced risk of PCP among patients with SLE (not use, reference; ≤14 g, OR 0.69, 95% CI 0.21-2.24; > 14 g, OR 0.20, 95% CI 0.05-0.71). Conclusions: This study demonstrated incident PCP was associated with mycophenolate mofetil/mycophenolic acid use and higher doses of cyclophosphamide or glucocorticoid, whereas the use of a higher dose of HCQ was associated with a reduced risk of PCP in lupus patients.

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

“…None of these patients were put on prophylaxis and all had LN, lymphopenia and low CD4+ T cell counts. Another registry study from Taiwan 63 reported an incidence of PJP of 0.24%, with higher risk in patients with severe LN (OR 6.7), those receiving higher doses of prednisone (5‐10 mg/d, OR 25.9; >10 mg/d, OR 287; compared to <5 mg/d), higher 3‐month cumulative dose of cyclophosphamide (≤1.4 g, OR 0.64; >1.4 g, OR 11.5; compared to no use) and use of MMF (OR 50.8). However, the 3‐month cumulative dose of hydroxychloroquine (HCQ) was associated with a reduced risk of pancytopenia (>14 g, OR 0.20; compared to no use).…”

Screening of Chloroquine, Hydroxychloroquine and its derivatives for their binding affinity to multiple SARS-CoV-2 protein drug targets

“…These drugs are believed to be relatively safe when administered within the clinically advised limits with mild side effects. Furthermore, Chloroquine derivatives have been tested on Pneumocystis pneumonia (PcP) for their therapeutic activity to repurposing antimalarial drugs for Pneumonia (Gomes et al, 2018;Yeo et al, 2020). Pneumonia is a lifethreatening symptom for advanced stage coronavirus infected patients and clinicians are using Chloroquine and its derivative Hydroxychloroquine to treat the disease.…”

Identifying rheumatic disease patients at high risk and requiring shielding during the COVID-19 pandemic

“…The risk for CMV viraemia is similar to that seen with azathioprine but the likelihood of tissue-invasive CMV disease is greater. 25 Neither sulfasalazine nor hydroxychloroquine are immunosuppressive, they do not appear to increase infection risk in rheumatic disease patients, and they may be protective against certain infections 27,28 and in the case of hydroxychloroquine against COVID-19 itself. 29 The latter is the subject of several ongoing clinical trials including the RECOVERY trial.…”