Increased risk of Pneumocystis jirovecii colonization in rheumatoid arthritis patients on biologics and Janus kinase inhibitor

被引：0
作者：
Huang, Ya-Chun [1 ]
Lee, Nan-Yao [2 ,3 ]
Weng, Meng-Yu [1 ]
机构：
[1] Natl Cheng Kung Univ, Natl Cheng Kung Univ Hosp, Coll Med, Dept Internal Med,Div Allergy Immunol & Rheumatol, Tainan, Taiwan
[2] Natl Cheng Kung Univ Hosp & Med Coll, Dept Internal Med, Tainan, Taiwan
[3] Natl Cheng Kung Univ Hosp & Med Coll, Ctr Infect Control, Tainan, Taiwan
来源：
JOURNAL OF MICROBIOLOGY IMMUNOLOGY AND INFECTION | 2025年 / 58卷 / 01期
关键词：
Rheumatoid arthritis; Biologics; Janus kinase inhibitor; Pneumocystis jirovecii colonization; REAL-TIME PCR; ACQUIRED-IMMUNODEFICIENCY-SYNDROME; POSTMARKETING SURVEILLANCE; CARINII-PNEUMONIA; B-CELLS; DISEASE; SAFETY; PREVALENCE; THERAPY; ASSAY;
D O I：
10.1016/j.jmii.2024.08.013
中图分类号：
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号：
100102 ;
摘要：
Background: The prevalence of Pneumocystis jirovecii (PJ) pneumonia among rheumatic patients is rising. PJ colonization serves as a reservoir for transmission and precedes the development of PJ pneumonia. We aim to clarify the association of PJ colonization in patients of rheumatoid arthritis (RA) treated with biologics or Janus kinase inhibitors (JAKi). Methods: A prospective cohort study was performed from March 2021 to July 2022 in the rheumatology outpatient department of National Cheng Kung University Hospital. We obtained oral-wash samples from asymptomatic RA patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs) and JAKi. A real-time quantitative polymerase chain reaction assay focusing on the mitochondrial large subunit ribosomal ribonucleic acid gene of PJ was applied to detect colonization. Results: One hundred and ten RA patients were enrolled. Adjusted odds ratios (ORs) of PJ colonization were 6.40 (95% CI 1.34-30.57, p-value =0.02) in patients receiving bDMARDs or JAKi. Specifically, in patients treated with bDMARDs the adjusted OR was 8.08 (95% CI 1.57-41.51, pvalue=0.012), and a trend toward developing PJ colonization was further identified in patients receiving JAKi (adjusted OR: 4.79, 95% CI 0.89-25.91, p=0.069). Among patients treated with bDMARDs or JAKi, medication duration >3 years and age >60 y/o are risk factors for PJ colonization. Conclusion: RA patients on bDMARDs or JAK inhibitors have an approximately 6-fold higher risk of developing P. jirovecii colonization. Patients treated with bDMARDs had an 8-fold higher risk of P. jirovecii colonization. Risk factors of PJ colonization are medication duration >3 years and age > 60 y/o.
引用
收藏
页码：112 / 119
页数：8
相关论文
共 40 条
  • [1] Smolen J.S., Landewe R.B.M., Bijlsma J.W.J., Burmester G.R., Dougados M., Kerschbaumer A., Et al., EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update, Ann Rheum Dis, 79, 6, pp. 685-699, (2020)
  • [2] Thomas C.F., Limper A.H., Pneumocystis pneumonia, N Engl J Med, 350, 24, pp. 2487-2498, (2004)
  • [3] Maini R., Henderson K.L., Sheridan E.A., Lamagni T., Nichols G., Delpech V., Et al., Increasing pneumocystis pneumonia, England, UK, 2000-2010, Emerg Infect Dis, 19, 3, pp. 386-392, (2013)
  • [4] Pegorie M., Denning D.W., Welfare W., Estimating the burden of invasive and serious fungal disease in the United Kingdom, J Infect, 74, 1, pp. 60-71, (2017)
  • [5] Godeau B., Coutant-Perronne V., Le Thi Huong D., Guillevin L., Magadur G., De Bandt M., Et al., Pneumocystis carinii pneumonia in the course of connective tissue disease: report of 34 cases, J Rheumatol, 21, 2, pp. 246-251, (1994)
  • [6] Yale S.H., Limper A.H., Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy, Mayo Clin Proc, 71, 1, pp. 5-13, (1996)
  • [7] Tokuda H., Sakai F., Yamada H., Johkoh T., Imamura A., Dohi M., Et al., Clinical and radiological features of Pneumocystis pneumonia in patients with rheumatoid arthritis, in comparison with methotrexate pneumonitis and Pneumocystis pneumonia in acquired immunodeficiency syndrome: a multicenter study, Intern Med, 47, 10, pp. 915-923, (2008)
  • [8] Bienvenu A.L., Traore K., Plekhanova I., Bouchrik M., Bossard C., Picot S., Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients, Int J Infect Dis, 46, pp. 11-17, (2016)
  • [9] Takeuchi T., Tatsuki Y., Nogami Y., Ishiguro N., Tanaka Y., Yamanaka H., Et al., Postmarketing surveillance of the safety profile of infliximab in 5000 Japanese patients with rheumatoid arthritis, Ann Rheum Dis, 67, 2, pp. 189-194, (2008)
  • [10] Koike T., Harigai M., Inokuma S., Inoue K., Ishiguro N., Ryu J., Et al., Postmarketing surveillance of the safety and effectiveness of etanercept in Japan, J Rheumatol, 36, 5, pp. 898-906, (2009)
1234