Hsu Hao-Chen, Huang Po-Wei, Cho Yung-Tsu, Chu Chia-Yu
Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan.
Department of Surgery and Section of Dermatology, National Taiwan University Cancer Center, Taipei, Taiwan.
Dermatol Ther (Heidelb). 2023 Jul;13(7):1561-1576. doi: 10.1007/s13555-023-00953-9. Epub 2023 Jun 15.
Pneumocystis jirovecii pneumonia (PJP) is a severe, life-threatening complication in patients treated with rituximab. However, there is no consensus on the primary prophylaxis for it in rituximab-treated pemphigus patients. Therefore, we sought to investigate the prophylactic efficacy and safety profile of cotrimoxazole for reducing the risk of developing PJP in pemphigus patients receiving rituximab.
This single-center retrospective study investigated 148 pemphigus patients undergoing a first cycle of rituximab between 2008 and 2021 at a tertiary referral center in northern Taiwan. Patients were divided into the prophylaxis group (N = 113) and the control group (N = 35) according to whether or not cotrimoxazole was administered. The primary outcome was the 1-year incidence of PJP in the two groups, while the secondary outcome was the incidence of cotrimoxazole-related adverse events.
Of the 148 patients enrolled in this study, three patients, all in the control group, developed PJP during the 1-year follow-up. The incidence of PJP (8.6%) in the control group was significantly higher than that in the prophylaxis group (0%) (p = 0.012). The incidence of cotrimoxazole-related adverse events was 2.7%, and none of the cases were associated with life-threatening conditions. In addition, the cumulative prednisolone dose was associated with a trend of a higher risk of PJP (p = 0.0483).
Prophylactic cotrimoxazole significantly reduces the risk of PJP in a certain high-risk population and has a tolerable safety profile.
耶氏肺孢子菌肺炎（PJP）是接受利妥昔单抗治疗的患者中一种严重的、危及生命的并发症。然而，对于利妥昔单抗治疗的天疱疮患者，其一级预防尚无共识。因此，我们试图研究复方新诺明在降低接受利妥昔单抗治疗的天疱疮患者发生PJP风险方面的预防效果和安全性。
这项单中心回顾性研究调查了2008年至2021年期间在台湾北部一家三级转诊中心接受首个利妥昔单抗疗程的148例天疱疮患者。根据是否使用复方新诺明，患者被分为预防组（N = 113）和对照组（N = 35）。主要结局是两组中PJP的1年发病率，次要结局是复方新诺明相关不良事件的发生率。
在本研究纳入的148例患者中，有3例患者（均在对照组）在1年随访期间发生了PJP。对照组中PJP的发病率（8.6%）显著高于预防组（0%）（p = 0.012）。复方新诺明相关不良事件的发生率为2.7%，且无一例与危及生命的情况相关。此外，累积泼尼松龙剂量与PJP风险较高的趋势相关（p = 0.0483）。
预防性使用复方新诺明可显著降低特定高危人群中PJP的风险，且具有可耐受的安全性。
