Aqeel Faten, Cammarata Michael Joseph, Le Dustin, Geetha Duvuru
Department of Internal Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Internal Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Glomerular Dis. 2024 Jul 26;4(1):152-158. doi: 10.1159/000539993. eCollection 2024 Jan-Dec.
Although an increased risk of pneumonia (PJP) has been reported in adults receiving rituximab for induction therapy, current evidence is lacking on the utility of PJP prophylaxis in ANCA-associated vasculitis (AAV) patients on maintenance rituximab therapy. The purpose of this study was to compare the incidence of PJP pneumonia and the outcomes of AAV patients with and without PJP prophylaxis.
We performed an observational, single-center, retrospective study examining patients with AAV in clinical remission and on rituximab maintenance therapy. We divided the patients into two groups: those with and without PJP prophylaxis. We explored factors associated with PJP prophylaxis use. We additionally looked at several outcomes, including PJP infections, infections requiring hospitalizations, end-stage kidney disease (ESKD), and death. Data were analyzed using test, Fisher's exact test, univariate, and multivariate logistic regression as appropriate.
A total of 129 patients with mean follow-up time of 7.2 (5.4) years were included: 44% received PJP prophylaxis and 56% of patients did not. There were no PJP infections in the entire cohort. Lung involvement was associated with increased odds of prescribing PJP prophylaxis (OR: 4.09 [95% CI: 1.8-9.82]). PJP prophylaxis did not decrease infection rates requiring hospitalizations, ESKD, or death. Glucocorticoid use, however, was associated with increased rates of infections requiring hospitalizations (OR: 5.54 [95% CI: 2.01-15.4]) and death (OR: 4.67 [95% CI: 1.36-15.71]) even after adjustment for age, gender, and use of PJP prophylaxis.
Regardless of the use of PJP prophylaxis during the maintenance phase of AAV management, PJP pneumonia was not observed. AAV patients with lung involvement were more likely to be on PJP prophylaxis.
尽管有报道称接受利妥昔单抗诱导治疗的成人患肺炎（肺孢子菌肺炎[PJP]）的风险增加，但目前缺乏关于在接受利妥昔单抗维持治疗的抗中性粒细胞胞浆抗体相关性血管炎（AAV）患者中进行PJP预防的效用的证据。本研究的目的是比较PJP肺炎的发生率以及接受和未接受PJP预防的AAV患者的结局。
我们进行了一项观察性、单中心、回顾性研究，检查处于临床缓解期且接受利妥昔单抗维持治疗的AAV患者。我们将患者分为两组：接受PJP预防的患者和未接受PJP预防的患者。我们探讨了与使用PJP预防相关的因素。我们还观察了几个结局，包括PJP感染、需要住院治疗的感染、终末期肾病（ESKD）和死亡。根据情况使用检验、Fisher精确检验、单因素和多因素逻辑回归分析数据。
共纳入了129例患者，平均随访时间为7.2（5.4）年：44%的患者接受了PJP预防，56%的患者未接受。整个队列中没有PJP感染。肺部受累与开具PJP预防处方的几率增加相关（比值比[OR]：4.09[95%置信区间（CI）：1.8 - 9.82]）。PJP预防并未降低需要住院治疗的感染率、ESKD或死亡率。然而，即使在调整年龄、性别和PJP预防的使用后，使用糖皮质激素仍与需要住院治疗的感染率增加（OR：5.54[95%CI：2.01 - 15.4]）和死亡率增加（OR：4.67[95%CI：1.36 - 15.71]）相关。
无论在AAV管理的维持阶段是否使用PJP预防，均未观察到PJP肺炎。肺部受累的AAV患者更有可能接受PJP预防。
