Division of Rheumatology, McGill University Health Centre, 1560 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd. W., Montreal, QC, H4A 3S9, Canada.
Arthritis Res Ther. 2023 Jul 29;25(1):133. doi: 10.1186/s13075-023-03114-7.
Antibiotic prophylaxis is recommended during ANCA-associated vasculitis (AAV) induction. We aimed to describe the frequency, persistence, and factors associated with trimethoprim-sulfamethoxazole (TMP-SMX) use in an adult population sample with granulomatosis with polyangiitis (GPA) treated with rituximab (RTX).
We identified adults with GPA treated with RTX within the Merative™ Marketscan® Research Databases (2011-2020). TMP-SMX prophylaxis was defined as a [Formula: see text] 28-day prescription dispensed within a month of starting RTX. We estimated TMP-SMX persistence, allowing prescription refill gaps of 30 days. Multivariable logistic regression and Cox proportional hazards regression assessed the factors associated with baseline TMP-SMX use and persistence, respectively. Covariates included age, sex, calendar year, insurance type, immunosuppressant use, hospitalization, and co-morbidities.
Among 1877 RTX-treated GPA patients, the mean age was 50.9, and 54% were female. A minority (n = 426, 23%) received TMP-SMX with a median persistence of 141 (IQR 83-248) days. In multivariable analyses, prophylaxis was associated with prednisone use in the month prior to RTX ([Formula: see text] 20 mg/day vs none, OR 3.96; 95% CI 3.0-5.2; 1-19 mg/day vs none, OR 2.63; 95% CI 1.8-3.8), and methotrexate use (OR 1.48, 95% CI 1.04-2.1), intensive care (OR 1.95; 95% CI 1.4-2.7), and non-intensive care hospitalization (OR 1.56; 95% CI 1.2-2.1) in the 6 months prior to RTX. Female sex (OR 0.63; 95% CI 0.5-0.8) was negatively associated with TMP-SMX use.
TMP-SMX was dispensed to a minority of RTX-treated GPA patients, more often to those on glucocorticoids and with recent hospitalization. Further research is needed to determine the optimal use and duration of TMP-SMX prophylaxis following RTX in AAV.
在抗中性粒细胞胞浆抗体相关性血管炎（AAV）诱导治疗期间建议使用抗生素预防。我们旨在描述在接受利妥昔单抗（RTX）治疗的肉芽肿性多血管炎（GPA）成年患者人群中，使用甲氧苄啶-磺胺甲恶唑（TMP-SMX）的频率、持续性及其相关因素。
我们在 Merative™ Marketscan® Research Databases（2011-2020 年）中确定了接受 RTX 治疗的 GPA 成年患者。TMP-SMX 预防定义为在开始 RTX 后一个月内开出的 [Formula: see text] 28 天处方。我们估计了 TMP-SMX 的持续性，允许处方再配药间隔 30 天。多变量逻辑回归和 Cox 比例风险回归分别评估了基线 TMP-SMX 使用和持续性的相关因素。协变量包括年龄、性别、日历年度、保险类型、免疫抑制剂使用、住院治疗和合并症。
在 1877 名接受 RTX 治疗的 GPA 患者中，平均年龄为 50.9 岁，54%为女性。少数患者（n=426，23%）接受了 TMP-SMX 治疗，其中位持续时间为 141（IQR 83-248）天。多变量分析显示，预防与 RTX 前一个月使用泼尼松有关（[Formula: see text] 20mg/天与无泼尼松相比，OR 3.96；95%CI 3.0-5.2；1-19mg/天与无泼尼松相比，OR 2.63；95%CI 1.8-3.8），以及使用甲氨蝶呤（OR 1.48，95%CI 1.04-2.1）、重症监护（OR 1.95；95%CI 1.4-2.7）和非重症监护住院治疗（OR 1.56；95%CI 1.2-2.1）。女性（OR 0.63；95%CI 0.5-0.8）与 TMP-SMX 的使用呈负相关。
TMP-SMX 被开给了少数接受 RTX 治疗的 GPA 患者，更多地用于使用糖皮质激素治疗和近期住院治疗的患者。需要进一步研究确定在 AAV 中 RTX 治疗后 TMP-SMX 预防的最佳使用和持续时间。
