Vasculitis & polymyalgia rheumatica
Trimethoprim sulfamethoxazole prophylaxis and serious infections in granulomatosis with polyangiitis treated with rituximab
Main finding · Serious infectionResult — go to the resultAdjusted hazard ratio 0.5 95% CI 0.3–0.9Authors' conclusion
TMP-SMX prophylaxis was associated with reduced serious infections in rituximab-treated GPA, but may increase adverse events, warranting further study of optimal prophylaxis strategies.
Study context
- Population
- Adults with granulomatosis with polyangiitis (GPA) (2011–2020) in the US Merative Marketscan Research Databases with ≥6 months' enrolment before first (index) rituximab (53% female; mean age 52.1 years)281 (31%) dispensed trimethoprim sulfamethoxazole (TMP-SMX) within 30 days
- Participants
- 919 adults
- Exposure
- TMP-SMX prophylaxis vs no TMP-SMX prophylaxis in rituximab-treated GPA
- Outcome
- Serious infection (hospital primary diagnosis for infection, excluding viral or mycobacterial codes)
Methodological detailstime-varying exposure, Cox proportional hazards regression, adjusted for potential confounders
- Time-varying exposure
- Cox proportional hazards regression
- Adjusted for potential confounders
Main finding
Serious infection
Adjusted hazard ratio
0.5
95% CI 0.3–0.9
TMP-SMXvs No TMP-SMX
aHR 0.5 (95% CI 0.3–0.9)
As reported in the abstract
- Serious infections overall: 130 in 104 individuals over median 496 (IQR 138-979) days; incidence per 100 person-years
- 6.1 (95% CI: 5.0, 7.4)
Observational data: associations, not effects.
Secondary outcomes
Outpatient infections (time-varying TMP-SMX)
- aHR for outpatient infections
- 0.8 (95% CI: 0.6, 1.1)
Pneumocystis jirovecii pneumonia (PJP) (time-varying TMP-SMX)
- PJP events
- 13
- Unadjusted HR for PJP
- 0.2 (95% CI: 0.03-1.8)
- Estimate imprecise
Safety
| Outcome | aHR (95% CI) | |
|---|---|---|
| Adverse events potentially attributable to TMP-SMX | 1.3 (0.9–1.9) | |
| 0.512Adjusted hazard ratio (log scale) |
Original publication
Trimethoprim sulfamethoxazole prophylaxis and serious infections in granulomatosis with polyangiitis treated with rituximab. Rheumatology (Oxford). Published 18 July 2024. doi:10.
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