Risk–Benefit Analysis of Primary Prophylaxis Against Pneumocystis Jirovecii Pneumonia in Patients With Rheumatic Diseases Receiving Rituximab

In this analysis it was shown that a combination of high-dose corticosteroid (>/= 30mg prednisone equivalent daily) and rituximab was associated with an incidence of 7.9 cases per 100 patient years and prophylaxis was effective.

SPS commentary:

The analysis is based on 11 cases of Pneumocystis Jirovecii Pneumonia (PJP) seen in a population of 818 patients treated with rituximab for rheumatic diseases of whom 419 had received prophylactic co-trimoxazole. PJP was associated with a mortality rate of 63.6%. Overall it was shown that 146 patients being treated with rituximab would need to be treated with co-trimoxazole to prevent one case of PVP but for every 86 patients treated one would have a serious adverse event. However if co-trimoxazole prophylaxis was restricted to patients receiving rituximab and high dose corticosteroid then the estimated number needed to treat fell to 20 (95%CI: 10.7 to 65.7) compared with 250 for those not taking high-dose corticosteroid.

Arthritis & Rheumatology

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