Pneumocystis jiroveci Pneumonia Prophylaxis Associated With Adverse Events in AAV

Patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) receiving Pneumocystis jiroveci pneumonia (PJP) prophylaxis are at greater risk for adverse events during the first 6 months of treatment, according to study findings published in Arthritis Care & Research.

Researchers evaluated adverse events associated with PJP prophylaxis and assessed PJP incidence among patients receiving treatment for AAV.

Data were taken from the TriNetX electronic health records database, comprised of information from 72 healthcare organizations. Patients with diagnostic-confirmed AAV who received at least one administration of rituximab or cyclophosphamide were included in the analysis. Incidence of PJP within 6 months of treatment initiation was the primary endpoint. Adverse events occurring within the 6-month period following treatment initiation were evaluated.

A total of 1461 patients with AAV were included in the analysis. Mean patient age was 56.2 years, 59.8% of patients were women, and 73.0% were White. Rituximab was most commonly used for induction therapy (69.7%).

Overall, 37.1% of patients received PJP prophylaxis within the first 30 days of induction therapy, with trimethoprim-sulfamethoxazole (30.7%) being most commonly used.

During the 6 months following treatment initiation, 10 cases of PJP occurred, corresponding to an incidence rate (IR) of 15.0 cases/1000 patient-years. No deaths occurred during this period.

A total of 709 patients were included in a subset analysis investigating rituximab maintenance therapy. An additional 5 cases of PJP were identified during this period, corresponding to an IR of 2.11 cases/1000 patient-years. One patient died while hospitalized with PJP.

Patients receiving vs not receiving prophylaxis were at greater risk for rash (hazard ratio [HR], 1.9; 95% CI, 1.0-3.6), nephropathy (HR, 2.6; 95% CI, 1.3-5.1), and leukopenia (HR, 3.1; 95% CI, 1.1-8.6), according to adjusted analyses.

Study limitations included potential missed diagnoses of PJP and under/miscoding of PJP and adverse events. Additionally, data on prophylaxis medication adherence was unknown. 

The study authors stated, “This study identified a lower incidence of PJP than previously observed.”

“Taken together, our study and similar recent real-world evaluations suggest that PJP may be less common among patients with AAV than previously assumed,” they concluded.  

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Rheumatology Advisor