Alfred Health, Pharmacy, Melbourne, Victoria, Australia.
Alfred Health, Haematology, Melbourne, Victoria, Australia.
Drug Metab Pers Ther. 2020 Jul 20;35(3):dmpt-2019-0018. doi: 10.1515/dmpt-2019-0018.
Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised individuals. The incidence can be as high as 80% in some groups but can be reduced to less than 1% with appropriate prophylaxis. HIV-infected patients with a low CD4 count are at the highest risk of PJP. Others at substantial risk include haematopoietic stem cell and solid organ transplant recipients, those with cancer (particularly haematologic malignancies), and those receiving glucocorticoids, chemotherapeutic agents, and other immunosuppressive medications. Trimethoprim-sulfamethoxazole is an established first-line line agent for prevention and treatment of PJP. However, in some situations, this medication cannot be used and dapsone is considered a suitable cost-effective second line agent. However, information on potential interactions with drugs commonly used in immunosuppressed patients is lacking or contradictory. In this this article we review the metabolic pathway of dapsone with a focus on interactions and clinical significance particularly in patients with haematological malignancies. An understanding of this process should optimise the use of this agent.
卡氏肺孢子虫肺炎（PJP）是一种潜在的危及生命的感染，发生在免疫功能低下的个体中。在某些人群中，其发病率可高达 80%，但通过适当的预防，发病率可降低到 1%以下。CD4 计数低的 HIV 感染患者患 PJP 的风险最高。其他高危人群包括造血干细胞和实体器官移植受者、患有癌症（特别是血液系统恶性肿瘤）的患者，以及接受糖皮质激素、化疗药物和其他免疫抑制药物治疗的患者。复方磺胺甲噁唑是预防和治疗 PJP 的既定一线药物。然而，在某些情况下，不能使用这种药物，而氨苯砜被认为是一种合适的具有成本效益的二线药物。然而，关于与免疫抑制患者常用药物潜在相互作用的信息缺乏或相互矛盾。在本文中，我们回顾了氨苯砜的代谢途径，重点关注相互作用及其在血液系统恶性肿瘤患者中的临床意义。了解这一过程应能优化该药物的使用。
