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Clinical Rheumatology

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23.09.2022 | Original Article

Combine use of glucocorticoid with other immunosuppressants is a risk factor for Pneumocystis jirovecii pneumonia in autoimmune inflammatory disease patients: a meta-analysis

verfasst von: Huyu Wang, Lili Shui, Yajuan Chen

Erschienen in: Clinical Rheumatology | Ausgabe 1/2023

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Abstract

Objective

To determine whether the combined use of glucocorticoid with other immunosuppressants increased the risk of Pneumocystis jirovecii pneumonia (PCP) in autoimmune inflammatory disease (AIID) patients.

Methods

The data were collected from the PubMed, Cochrane Library, and Web of Science databases. We excluded HIV-infected patients and those < 16 years of age, and included patients who combined use of glucocorticoid with other immunosuppressants or used glucocorticoid alone. The number of patients who were affected by PCP after therapy as the primary outcome and the number of patients with fatal outcomes, which included death, endotracheal tube intubation, PO₂ < 60 mmHg, and other serious clinical symptoms due to PCP, as the secondary outcome. Odds ratios with 95% confidence intervals and variance tests were used to analyze the data.

Results

The outcomes showed that the combined use of glucocorticoid with other immunosuppressants increased the risk of PCP in AIID patients (odds ratio = 2.85, 95% confidence intervals 1.75 to 4.64, I² = 0%, P < 0.0001), which may be a consequence of the drug regimen reducing the lymphocyte count. Furthermore, the prognosis of patients receiving this drug regimen was poorer than with glucocorticoid alone (odds ratio = 2.31, 95% confidence intervals 1.02 to 5.23, I² = 0%, P = 0.04).

Conclusion

The combined use of glucocorticoid with other immunosuppressants increased the risk of PCP in AIID patients and resulted in poorer prognoses. It is therefore clear that appropriate prophylaxis was vital in AIID patients to minimize the risk of PCP.

Key Points

• We demonstrated that the combined use of glucocorticoid with other immunosuppressants increased the risk of PCP in AIID patients and resulted in poorer prognoses.

• As there are no standard prophylactic guidelines, we wish this work will be evidence to guide clinical prophylaxis.

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Green H, Paul M, Vidal L et al (2007) Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. Cochrane Database Syst Rev (3):CD005590. https://doi.org/10.1002/14651858.CD005590.pub2

Kim SJ, Lee J, Cho YJ et al (2014) Prognostic factors of Pneumocystis jirovecii pneumonia in patients without HIV infection. J Infect 69(1):88–95. https://doi.org/10.1016/j.jinf.2014.02.015CrossRef

Roblot F, Godet C, Le Moal G et al (2002) Analysis of underlying diseases and prognosis factors associated with Pneumocystis carinii pneumonia in immunocompromised HIV-negative patients. Eur J Clin Microbiol Infect Dis 21(7):523–531. https://doi.org/10.1007/s10096-002-0758-5CrossRef

Cillóniz C, Dominedò C, Álvarez-Martínez MJ et al (2019) Pneumocystis pneumonia in the twenty-first century: HIV-infected versus HIV-uninfected patients. Expert Rev Anti Infect Ther 17(10):787–801. https://doi.org/10.1080/14787210.2019.1671823CrossRef

Kaplan JE, Benson C, Holmes KK et al (2009) Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 58(RR-4):1–207

Spies CM, Strehl C, van der Goes MC et al (2011) Glucocorticoids. Best Pract Res Clin Rheumatol 25(6):891–900. https://doi.org/10.1016/j.berh.2011.11.002CrossRef

Kondoh Y, Makino S, Ogura T et al (2021) 2020 guide for the diagnosis and treatment of interstitial lung disease associated with connective tissue disease. Respir Investig 59(6):709–740. https://doi.org/10.1016/j.resinv.2021.04.011CrossRef

Lionakis MS, Kontoyiannis DP (2003) Glucocorticoids and invasive fungal infections. Lancet 362(9398):1828–1838. https://doi.org/10.1016/S0140-6736(03)14904-5CrossRef

Park JW, Curtis JR, Moon J et al (2018) Prophylactic effect of trimethoprim-sulfamethoxazole for pneumocystis pneumonia in patients with rheumatic diseases exposed to prolonged high-dose glucocorticoids. Ann Rheum Dis 77(5):644–649. https://doi.org/10.1136/annrheumdis-2017-211796CrossRef

10.

Glück T, Geerdes-Fenge HF, Straub RH et al (2000) Pneumocystis carinii pneumonia as a complication of immunosuppressive therapy. Infection 28(4):227–30. https://doi.org/10.1007/s150100070041CrossRef

11.

Minderhoud TC, van Meer MPA, van Thiel RJ et al (2018) Infecties bij gebruik van glucocorticoïden [Infections during glucocorticoid use. Ned Tijdschr Geneeskd 30(162):D2215

12.

Chew LC, Maceda-Galang LM, Tan YK et al (2015) Pneumocystis jirovecii pneumonia in patients with autoimmune disease on high-dose glucocorticoid. J Clin Rheumatol 21(2):72–75. https://doi.org/10.1097/RHU.0000000000000215CrossRef

13.

Kamel S, O’Connor S, Lee N et al (2010) High incidence of Pneumocystis jirovecii pneumonia in patients receiving biweekly rituximab and cyclophosphamide, adriamycin, vincristine, and prednisone. Leuk Lymphoma 51(5):797–801. https://doi.org/10.3109/10428191003699860CrossRef

14.

Okada J, Kadoya A, Rana M et al (1999) Efficacy of sulfamethoxazole-trimethoprim administration in the prevention of Pneumocystis carinii pneumonia in patients with connective tissue disease. Kansenshogaku Zasshi 73(11):1123–9. https://doi.org/10.11150/kansenshogakuzasshi1970.73.1123CrossRef

15.

Li F, Jin HZ, Su F et al (2011) Pneumocystis pneumonia in patients with immunobullous dermatoses. Int J Dermatol 50(9):1144–1149. https://doi.org/10.1111/j.1365-4632.2010.04857.xCrossRef

16.

Mekinian A, Durand-Joly I, Hatron PY et al (2011) Pneumocystis jirovecii colonization in patients with systemic autoimmune diseases: prevalence, risk factors of colonization and outcome. Rheumatology (Oxford) 50(3):569–577. https://doi.org/10.1093/rheumatology/keq314CrossRef

17.

Gerhart JL, Kalaaji AN (2010) Development of Pneumocystis carinii pneumonia in patients with immunobullous and connective tissue disease receiving immunosuppressive medications. J Am Acad Dermatol 62(6):957–961. https://doi.org/10.1016/j.jaad.2009.07.042CrossRef

18.

Ogawa J, Harigai M, Nagasaka K et al (2005) Prediction of and prophylaxis against Pneumocystis pneumonia in patients with connective tissue diseases undergoing medium- or high-dose corticosteroid therapy. Mod Rheumatol 15(2):91–96. https://doi.org/10.1007/pl00021707CrossRef

19.

Migita K, Arai T, Ishizuka N et al (2013) Rates of serious intracellular infections in autoimmune disease patients receiving initial glucocorticoid therapy. PLoS One 8(11):e78699. https://doi.org/10.1371/journal.pone.0078699CrossRef

20.

Iikuni N, Kitahama M, Ohta S et al (2006) Evaluation of Pneumocystis pneumonia infection risk factors in patients with connective tissue disease. Mod Rheumatol 16(5):282–288. https://doi.org/10.1007/s10165-006-0502-6CrossRef

21.

Vananuvat P, Suwannalai P, Sungkanuparph S et al (2011) Primary prophylaxis for Pneumocystis jirovecii pneumonia in patients with connective tissue diseases. Semin Arthritis Rheum 41(3):497–502. https://doi.org/10.1016/j.semarthrit.2011.05.004CrossRef

22.

Komano Y, Harigai M, Koike R et al (2009) Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: a retrospective review and case-control study of 21 patients. Arthritis Rheum 61(3):305–312. https://doi.org/10.1002/art.24283CrossRef

23.

Tanaka M, Sakai R, Koike R et al (2012) Pneumocystis jirovecii pneumonia associated with etanercept treatment in patients with rheumatoid arthritis: a retrospective review of 15 cases and analysis of risk factors. Mod Rheumatol 22(6):849–858. https://doi.org/10.1007/s10165-012-0615-zCrossRef

24.

Watanabe K, Sakai R, Koike R et al (2013) Clinical characteristics and risk factors for Pneumocystis jirovecii pneumonia in patients with rheumatoid arthritis receiving adalimumab: a retrospective review and case-control study of 17 patients. Mod Rheumatol 23(6):1085–1093. https://doi.org/10.1007/s10165-012-0796-5CrossRef

25.

Yukawa K, Nagamoto Y, Watanabe H et al (2018) Risk factors for Pneumocystis jirovecii pneumonia in patients with rheumatoid arthritis and a prophylactic indication of trimethoprim/sulfamethoxazole. J Clin Rheumatol 24(7):355–360. https://doi.org/10.1097/RHU.0000000000000731CrossRef

26.

Enomoto T, Azuma A, Kohno A et al (2010) Differences in the clinical characteristics of Pneumocystis jirovecii pneumonia in immunocompromized patients with and without HIV infection. Respirology 15(1):126–131. https://doi.org/10.1111/j.1440-1843.2009.01660.xCrossRef

27.

Wickramasekaran RN, Jewell MP, Sorvillo F et al (2017) The changing trends and profile of pneumocystosis mortality in the United States, 1999–2014. Mycoses 60(9):607–615. https://doi.org/10.1111/myc.12636CrossRef

28.

Sato T, Inokuma S, Maezawa R et al (2005) Clinical characteristics of Pneumocystis carinii pneumonia in patients with connective tissue diseases. Mod Rheumatol 15(3):191–197. https://doi.org/10.1007/s10165-005-0395-9CrossRef

29.

Green H, Paul M, Vidal L et al (2007) Prophylaxis of Pneumocystis pneumonia in immunocompromised non-HIV-infected patients: systematic review and meta-analysis of randomized controlled trials. Mayo Clin Proc 82(9):1052–1059. https://doi.org/10.4065/82.9.1052CrossRef

30.

Stern A, Green H, Paul M et al (2014) Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. Cochrane Database Syst Rev 2014(10):CD005590. https://doi.org/10.1002/14651858.CD005590.pub3CrossRef

31.

Lertnawapan R, Totemchokchyakarn K, Nantiruj K et al (2009) Risk factors of Pneumocystis jeroveci pneumonia in patients with systemic lupus erythematosus. Rheumatol Int 29(5):491–496. https://doi.org/10.1007/s00296-008-0721-6CrossRef

32.

Kadoya A, Okada J, Iikuni Y et al (1996) Risk factors for Pneumocystis carinii pneumonia in patients with polymyositis/dermatomyositis or systemic lupus erythematosus. J Rheumatol 23(7):1186–1188

33.

Tadros S, Teichtahl AJ, Ciciriello S et al (2017) Pneumocystis jirovecii pneumonia in systemic autoimmune rheumatic disease: a case-control study. Semin Arthritis Rheum 46(6):804–809. https://doi.org/10.1016/j.semarthrit.2016.09.009CrossRef

34.

Duarte AC, Cordeiro A, Fernandes BM et al (2019) Rituximab in connective tissue disease-associated interstitial lung disease. Clin Rheumatol 38(7):2001–2009. https://doi.org/10.1007/s10067-019-04557-7CrossRef

35.

Sharp C, Dodds N, Mayers L et al (2015) The role of biologics in treatment of connective tissue disease-associated interstitial lung disease. QJM 108(9):683–688. https://doi.org/10.1093/qjmed/hcv007CrossRef

36.

Kovacs JA, Masur H (2009) Evolving health effects of Pneumocystis: one hundred years of progress in diagnosis and treatment. JAMA 301(24):2578–2585. https://doi.org/10.1001/jama.2009.880CrossRef

37.

Tomblyn M, Chiller T, Einsele H et al (2009) Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 15(10):1143–1238. https://doi.org/10.1016/j.bbmt.2009.06.019CrossRef

38.

Martin SI, Fishman JA (2013) AST infectious diseases community of practice. Pneumocystis pneumonia in solid organ transplantation. Am J Transplant 13(Suppl 4):272–9. https://doi.org/10.1111/ajt.12119CrossRef

Titel: Combine use of glucocorticoid with other immunosuppressants is a risk factor for Pneumocystis jirovecii pneumonia in autoimmune inflammatory disease patients: a meta-analysis
verfasst von: Huyu Wang
Lili Shui
Yajuan Chen
Publikationsdatum: 23.09.2022
Verlag: Springer International Publishing
Erschienen in: Clinical Rheumatology / Ausgabe 1/2023
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-022-06381-y

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