Risk–Benefit Analysis of Primary Prophylaxis Against Pneumocystis Jirovecii Pneumonia in Patients With Rheumatic Diseases Receiving Rituximab
Main finding · PJP incidenceResult — go to the resultHazard ratio 0.11 95% CI 0.03–0.43Authors' conclusion
The benefit associated with primary PJP prophylaxis outweighs the risk of severe AEs in patients with rheumatic diseases receiving rituximab and concomitant high-dose glucocorticoid treatment.
Study context
- Population
- Patients treated with RTX for rheumatic diseases
- Participants
- 818 patients663.1 person-years
- Exposure
- Prophylactic TMP/SMX with RTX vs no prophylaxis
- TMP/SMXn = 419
- Outcome
- PJP incidence
- Follow-up
- 1 year
Methodological detailsinverse probability of treatment weighting, Cox proportional hazards regression, risk-benefit analysis (NNT vs NNH)
- Inverse probability of treatment weighting
- Cox proportional hazards regression
- Risk-benefit analysis (NNT vs NNH)
Main finding
As reported in the abstract
Hazard ratio
0.11
95% CI 0.03–0.43
TMP/SMXvs No prophylaxis
HR 0.11 (95% CI 0.03–0.43)
- NNT to prevent 1 case of Pneumocystis jirovecii pneumonia (PJP)
- 146
- NNH (severe adverse events (AEs))
- 86
Observational data: associations, not effects.
Further findings
per 100 person-years
High-dose GC
7.93 (95% CI 2.91–17.25) per 100 person-years
Without high-dose GC
0.40 (95% CI 0.01–2.25) per 100 person-years
- High-dose GC the most important risk factor
PJP cases and mortality (overall)
- PJP cases
- 11
- Mortality rate
- 63.6%
NNT to prevent 1 PJP case in patients receiving concomitant high-dose GC (subgroup)
- NNT
- 20 (95% CI 10.7-65.7)
Safety
NNH due to severe AEs (TMP/SMX)
- NNH
- 86
Original publication
Risk–Benefit Analysis of Primary Prophylaxis Against Pneumocystis Jirovecii Pneumonia in Patients With Rheumatic Diseases Receiving Rituximab. Arthritis Rheumatol. Published 22 August 2023. doi:10.
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