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01.11.2012 | Original Article

Pneumocystis jirovecii pneumonia associated with etanercept treatment in patients with rheumatoid arthritis: a retrospective review of 15 cases and analysis of risk factors

verfasst von: Michi Tanaka, Ryoko Sakai, Ryuji Koike, Yukiko Komano, Toshihiro Nanki, Fumikazu Sakai, Haruhito Sugiyama, Hidekazu Matsushima, Toshihisa Kojima, Shuji Ohta, Yoji Ishibe, Takuya Sawabe, Yasuhiro Ota, Kazuhisa Ohishi, Hajime Miyazato, Yoshinori Nonomura, Kazuyoshi Saito, Yoshiya Tanaka, Hayato Nagasawa, Tsutomu Takeuchi, Ayako Nakajima, Hideo Ohtsubo, Makoto Onishi, Yoshinori Goto, Hiroaki Dobashi, Nobuyuki Miyasaka, Masayoshi Harigai

Erschienen in: Modern Rheumatology | Ausgabe 6/2012

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Abstract

Objectives

The association of anti-tumor necrosis factor therapy with opportunistic infections in rheumatoid arthritis (RA) patients has been reported. The goal of this study was to clarify the clinical characteristics and the risk factors of RA patients who developed Pneumocystis jirovecii pneumonia (PCP) during etanercept therapy.

Methods

We conducted a multicenter, case–control study in which 15 RA patients who developed PCP were compared with 74 RA patients who did not develop PCP during etanercept therapy.

Results

PCP developed within 26 weeks following the first injection of etanercept in 86.7% of the patients. All PCP patients presented with a rapid and severe clinical course and the overall mortality was 6.7%. Independent risk factors were identified using multivariate analysis and included age ≥65 years [hazard ratio (HR) 3.35, p = 0.037], coexisting lung disease (HR 4.48, p = 0.009), and concomitant methotrexate treatment (HR 4.68, p = 0.005). In patients having a larger number of risk factors, the cumulative probability of developing PCP was significantly higher (p < 0.001 for patients with two or more risk factors vs. those with no risk factor, and p = 0.001 for patients with one risk factor vs. those with no risk factor).

Conclusion

Physicians must consider the possibility of PCP developing during etanercept therapy in RA patients, particularly if one or more risk factors are present.

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Titel: Pneumocystis jirovecii pneumonia associated with etanercept treatment in patients with rheumatoid arthritis: a retrospective review of 15 cases and analysis of risk factors
verfasst von: Michi Tanaka
Ryoko Sakai
Ryuji Koike
Yukiko Komano
Toshihiro Nanki
Fumikazu Sakai
Haruhito Sugiyama
Hidekazu Matsushima
Toshihisa Kojima
Shuji Ohta
Yoji Ishibe
Takuya Sawabe
Yasuhiro Ota
Kazuhisa Ohishi
Hajime Miyazato
Yoshinori Nonomura
Kazuyoshi Saito
Yoshiya Tanaka
Hayato Nagasawa
Tsutomu Takeuchi
Ayako Nakajima
Hideo Ohtsubo
Makoto Onishi
Yoshinori Goto
Hiroaki Dobashi
Nobuyuki Miyasaka
Masayoshi Harigai
Publikationsdatum: 01.11.2012
Verlag: Springer Japan
Erschienen in: Modern Rheumatology / Ausgabe 6/2012
Print ISSN: 1439-7595
Elektronische ISSN: 1439-7609
DOI: https://doi.org/10.1007/s10165-012-0615-z

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Pneumocystis jirovecii pneumonia associated with etanercept treatment in patients with rheumatoid arthritis: a retrospective review of 15 cases and analysis of risk factors