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. 2023 Jul;13(7):1561-1576.
doi: 10.1007/s13555-023-00953-9. Epub 2023 Jun 15.

Cotrimoxazole as a Preventative Intervention for Pneumocystis Pneumonia in Pemphigus Patients Treated with Rituximab: A Retrospective Study

Hao-Chen Hsu  1 , Po-Wei Huang  1   2 , Yung-Tsu Cho  1 , Chia-Yu Chu  3
Affiliations

Cotrimoxazole as a Preventative Intervention for Pneumocystis Pneumonia in Pemphigus Patients Treated with Rituximab: A Retrospective Study

Hao-Chen Hsu et al. Dermatol Ther (Heidelb). 2023 Jul.

Abstract

Introduction: 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.

Methods: 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.

Results: 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).

Conclusions: Prophylactic cotrimoxazole significantly reduces the risk of PJP in a certain high-risk population and has a tolerable safety profile.

Keywords: Corticosteroid; Cotrimoxazole; Pemphigus; Pneumocystis pneumonia; Prophylaxis; Rituximab.

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Conflict of interest statement

Hao-Chen Hsu, Po-Wei Huang, Yung-Tsu Cho, and Chia-Yu Chu declare that they have no competing interests.

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