Clinical Factors Associated With Pneumocystis Pneumonia Despite Its Primary Prophylaxis: When to Stop Prophylaxis?
Authors' conclusion
Tapering glucocorticoids with 12.5 mg/day of prednisone equivalent could be a reasonable timepoint to initiate the withdrawal of PJP prophylaxis in patients with rheumatic diseases.
Study context
- Population
- Patients with rheumatic disease who received immunosuppressants and prophylactic trimethoprim-sulfamethoxazole (TMP-SMX)
- Participants
- 1,148 patients1,294 prophylactic episodes
- Comparison
- Pneumocystis jirovecii pneumonia (PJP) vs control despite TMP-SMX prophylaxis
- PJPn = 10
- Outcome
- One-year incidence of PJP
- Follow-up
- One year
Methodological detailsCox proportional hazards model with least absolute shrinkage and selection operator
- Cox proportional hazards model with least absolute shrinkage and selection operator
Main finding
As reported in the abstract
Incidence of PJP
PJP cases during 1,174 person-years
10
Incidence rate per 100 person-years
0.85
Observational data: associations, not effects.
Further findings
GC dose at TMP-SMX discontinuation
Risk of PJP when TMP-SMX discontinued while on a GC dose >12.5 mg/day of prednisone equivalent
| aHR (95% CI) | ||
|---|---|---|
| Discontinuing TMP-SMX while on a GC dose >12.5 mg/day of prednisone equivalent | 13.84 (1.71–111.80) | |
| 0.050.21520Adjusted hazard ratio (log scale) |
GC dose at TMP-SMX discontinuation
- Significantly higher in the PJP group relative to the control group
Safety
- Adverse events during observation
- 63
- Attributed to TMP-SMX with probable causality
- 10 (15.9%)
Original publication
Clinical Factors Associated With Pneumocystis Pneumonia Despite Its Primary Prophylaxis: When to Stop Prophylaxis? Arthritis Rheumatol. Published 8 May 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →