Pneumocystic Pneumonia Risk Preventable for RA Patients on Biologics

February 12, 2014

Rheumatologists can dramatically reduce the chances of an infection common to RA patients on biologics -- pneumocystis pneumonia (PCP) – with a simple regimen of prophylactic antibiotics, a small study suggests.

Katsuyama T, Saito K, Kubo S, et al. The prophylaxis for Pneumocystis pneumonia in patients with rheumatoid arthritis treated with biologics, based on risk factors found in a retrospective study.Arthritis Res Ther. (2014 5(1):R43. [Epub ahead of print]

Rheumatologists can dramatically reduce the chances of an infection common to RA patients on biologics -- pneumocystis pneumonia (PCP) – with a simple regimen of antibiotics, according to this report.

The retrospective study from Japan, where PCP is more common than in Western countries, focused on 702 RA patients, mostly women in their late 50s. It found three major risk factors for PCP among those taking biologics: coexisting lung disease, concurrent corticosteroid use, and being age 65 or older.

In a second study , patients with 2 or 3 of those risk factors took a combination of trimethoprim and sulfamethoxazole (TMP/SMX) at the start of biologic treatment (either TNF-α or IL-6 inhibitors). There were no cases of PCP over almost six months.

in the entire study group, PCP developed in nine of the 702 patients (1.28%), none of whom were taking prophylactic antibiotics.

The prophylactic regimen consisted of 80 mg of TMP and 400 mg of SMX, either as a single tablet every day or as two pills three times a week. Patients who experienced adverse events were switched to 300 mg of inhaled aerosolized pentamidine once a month.

Of the 214 at-risk patients, 94 were given TMP/SMX with no severe adverse events.

PCP is one of the most widespread opportunistic infections among patients taking immunosuppressive therapy.

As the numbers were small and the condition more prevalent in Japan than in Western countries, the results need to be validated elsewhere.