Trimethoprim sulfamethoxazole prophylaxis and serious infections in granulomatosis with polyangiitis treated with rituximab.

IF 4.7 2区医学 Q1 RHEUMATOLOGY

Rheumatology Pub Date : 2025-04-01 DOI:10.1093/rheumatology/keae368

Arielle Mendel, Hassan Behlouli, Évelyne Vinet, Jeffrey R Curtis, Sasha Bernatsky

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引用次数: 0

Abstract

Objective: To assess the association of trimethoprim sulfamethoxazole (TMP-SMX) prophylaxis with serious infections in rituximab-treated patients with granulomatosis with polyangiitis (GPA).

Methods: This retrospective cohort study included adults with GPA (2011-2020) within the United States Merative™ Marketscan® Research Databases with ≥6 months' enrolment prior to first (index) rituximab treatment. We defined TMP-SMX prophylaxis as a ≥28-day prescription dispensed after or overlapping the index date. Serious infection was a hospital primary diagnosis for infection (excluding viral or mycobacterial codes). Secondary outcomes were outpatient infection, Pneumocystis jirovecii pneumonia (PJP) and adverse events potentially attributable to TMP-SMX. Cox proportional hazards regression assessed the association of time-varying TMP-SMX with outcomes of interest, adjusting for potential confounders. Individuals were followed until the outcome of interest, end of database enrolment or 31 Decamber 2020.

Results: Among 919 rituximab-treated individuals (53% female), mean (s.d.) age was 52.1 (16) years and 281 (31%) were dispensed TMP-SMX within 30 days of index date. Over a median of 496 (interquartile range 138-979) days, 130 serious infections occurred among 104 individuals (incidence 6.1 [95% CI: 5.0, 7.4] per 100 person-years). Time-varying TMP-SMX was negatively associated with serious infection (adjusted hazard ratio [aHR] 0.5; 95% CI: 0.3, 0.9). The aHR for outpatient infections was 0.8 (95% CI: 0.6, 1.1). The estimate for PJP was imprecise (13 events, unadjusted HR 0.2; 95% CI: 0.03-1.8). TMP-SMX was potentially associated with adverse events (aHR 1.3; 95% CI: 0.9, 1.9).

Conclusions: 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.

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使用利妥昔单抗治疗肉芽肿伴多血管炎时的甲氧苄胺磺胺甲噁唑预防措施和严重感染。

目的评估利妥昔单抗治疗的多血管炎肉芽肿病（GPA）患者中，三甲双胍-磺胺甲噁唑（TMP-SMX）预防与严重感染的相关性：这项回顾性队列研究纳入了美国 Merative™ Marketscan® 研究数据库中首次（指数）利妥昔单抗治疗前注册时间≥6 个月的成人 GPA 患者（2011-2020 年）。我们将 TMP-SMX 预防定义为在指标日期之后或与指标日期重叠的≥28 天的处方。严重感染是指医院的主要感染诊断（不包括病毒或霉菌感染）。次要结果为门诊感染、PJP 和可能由 TMP-SMX 引起的不良事件。Cox 比例危险度回归评估了随时间变化的 TMP-SMX 与相关结果的关系，并对潜在的混杂因素进行了调整。对患者进行随访，直至出现相关结果、数据库注册结束或2020年12月31日：在 919 名接受利妥昔单抗治疗的患者中（53% 为女性），平均年龄为 52.1 岁（SD 16），281 人（31%）在指标日期后 30 天内获得了 TMP-SMX。在中位数为 496（IQR 138，979）天的时间内，104 人中发生了 130 例严重感染（发生率为 6.1 [95% CI 5.0-7.4]/100人-年）。随时间变化的 TMP-SMX 与严重感染呈负相关（调整后 HR 0.5；95% CI 0.3-0.9）。门诊感染的 aHR 为 0.8（95% CI 0.6-1.1）。PJP 的估计值不精确（13 例，未调整 HR 0.2；95% CI 0.03-1.8）。TMP-SMX可能与不良事件有关（aHR 1.3；95% CI 0.9-1.9）：结论：在利妥昔单抗治疗的GPA患者中，TMP-SMX预防可减少严重感染，但可能会增加不良事件，因此需要进一步研究最佳预防策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Rheumatology 医学-风湿病学

CiteScore

9.40

自引率

7.30%

发文量

1091

审稿时长

2 months

期刊介绍： Rheumatology strives to support research and discovery by publishing the highest quality original scientific papers with a focus on basic, clinical and translational research. The journal’s subject areas cover a wide range of paediatric and adult rheumatological conditions from an international perspective. It is an official journal of the British Society for Rheumatology, published by Oxford University Press. Rheumatology publishes original articles, reviews, editorials, guidelines, concise reports, meta-analyses, original case reports, clinical vignettes, letters and matters arising from published material. The journal takes pride in serving the global rheumatology community, with a focus on high societal impact in the form of podcasts, videos and extended social media presence, and utilizing metrics such as Altmetric. Keep up to date by following the journal on Twitter @RheumJnl.