Comparative effectiveness of trimethoprim-sulfamethoxazole versus atovaquone for the prophylaxis of pneumocystis pneumonia in patients with connective tissue diseases receiving prolonged high-dose glucocorticoids

被引：10

作者：

Jinno, Sadao ^{[1
]}

Akashi, Kengo ^{[1
]}

Onishi, Akira ^{[2
]}

Nose, Yoko ^{[1
]}

Yamashita, Mai ^{[1
]}

Saegusa, Jun ^{[1
]}

机构：

[1] Univ Grad Sch Med, Dept Rheumatol & Clin Immunol, 7-5-2 Kusunoki Chou, Kobe, Hyogo 6500017, Japan

[2] Kyoto Univ, Grad Sch Med, Dept Adv Med Rheumat Dis, Kyoto, Japan

来源：

RHEUMATOLOGY INTERNATIONAL | 2022年 / 42卷 / 08期

关键词：

Antifungal agents; therapeutic use; Atovaquone; pharmacology; Incidence; Pneumocystis pneumonia; prevention and control; Rheumatic diseases; drug therapy; Trimethoprim sulfamethoxazole drug combination; AEROSOLIZED PENTAMIDINE; JIROVECII PNEUMONIA; CARINII-PNEUMONIA; SUSPENSION; BLOOD;

D O I：

10.1007/s00296-021-04945-w

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

We compared the prophylactic effect of trimethoprim-sulfamethoxazole (TMP-SMX) with atovaquone for pneumocystis pneumonia (PCP) in patients with connective tissue diseases (CTDs) receiving high-dose glucocorticoids. Patients with CTDs aged >= 18 years who were treated with a prolonged course (>= 4 weeks) of glucocorticoids (>= 20 mg/day prednisone) in a Japanese tertiary center between 2013 and 2017 were included. The patients were categorized into two groups: TMP-SMX and atovaquone group. Adjusted cumulative incidence of PCP was compared between the two groups after propensity score weighting for differences in confounding factors. A total of 480 patients with a prolonged high-dose glucocorticoid treatment were identified. Out of 383 patients with TMP-SMX prophylaxis, 102 (26.8%) patients experienced adverse events leading to discontinuation within 4 weeks of initiation, while no patient in the atovaquone discontinued the therapy. Two hundred eighty-one patients received TMP-SMX, while 107 received atovaquone for PCP prophylaxis. During a total of 397.0 person-years, 7 PCP cases (2 in the TMP-SMX, 5 in the atovaquone) occurred with a mortality rate of 54.5%. After adjusting for differences in baseline characteristics, the adjusted cumulative incidence of PCP was similar between the two group (HR 0.97, 95% CI 0.19-5.09, p = 0.97). Prophylactic effects for PCP in CTDs patients receiving prolonged high-dose glucocorticoids were similar between TMP-SMX and atovaquone. Atovaquone was well-tolerated with no side effects.

引用

页码：1403 / 1409

页数：7

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