The efficacy and safety of reduced-dose sulfamethoxazole-trimethoprim for chemoprophylaxis of Pneumocystis pneumonia in patients with rheumatic diseases. Issue 3 (4th May 2021)

• Record Type: Journal Article
• Authors: Harada, Tomoya; Kato, Ryohei; Sueda, Yuriko; Funaki, Yoshihiro; Takata, Miki; Okazaki, Ryota; Hasegawa, Yasuyuki; Yamasaki, Akira
• Is Part Of: Modern rheumatology. Volume 31:Issue 3(2021)
• Page Start: 629
• Page End: 635
• Publication Date: 2021-05-04
• Subjects: Dose reduction -- efficacy -- pneumocystis pneumonia -- prophylaxis -- sulfamethoxazole-trimethoprim; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1080/14397595.2020.1812834
• Languages: English
• ISSNs: 1439-7595

Abstract

Abstract: Objectives: Pneumocystis pneumonia (PCP) is a life-threatening opportunistic infection. Sulfamethoxazole-trimethoprim (SMX/TMP) is the first-line drug for PCP prophylaxis. However, adverse events (AEs) force clinicians to alter or reduce the drug dosage. Methods: We retrospectively reviewed all patients with rheumatic diseases who received SMX/TMP for prophylaxis and glucocorticoid therapy between April 2004 and March 2018. The rates of AEs, SMX/TMP discontinuation, and incidence of PCP were analyzed. Patients were divided into the conventional group and the dose-reduction group. Results: One hundred forty-five patients and 75 patients were included in the conventional group and the dose-reduction group, respectively. Compared to the dose-reduction group, the conventional group had a significantly high frequency of AEs (10.7% vs. 24.1%; p = .017); however, the rate of discontinuing SMX/TMP was not significantly different (8.0% vs. 14.5%; p = .165). Thirteen conventional group patients required a reduced SMX/TMP dose because of AEs; no patient developed PCP. The conventional SMX/TMP dose and renal dysfunction were associated with AEs in multivariate analysis. Conclusion: Patients who received a reduced SMX/TMP dose did not have PCP and had a lower frequency of AEs. A reduction in SMX/TMP for PCP prophylaxis is effective and safe in patients with rheumatic disease.