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Onishi, Takahisa Department of Rheumatology, Kakogawa Central City Hospital
Sada, Ken-Ei Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine
Hayashi, Keigo Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine
Miyawaki, Yoshia Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine ORCID Kaken ID publons researchmap
Yoshimi, Ryusuke Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine
Shimojima, Yasuhiro Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine
Ohno, Shigeru Center for Rheumatic Diseases, Yokohama City University Medical Center
Kajiyama, Hiroshi Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University
Ichinose, Kunihiro Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
Sato, Shuzo Department of Rheumatology, Fukushima Medical University School of Medicine
Fujiwara, Michio Department of Rheumatology, Yokohama Rosai Hospital
Yajima, Nobuyuki Division of Rheumatology, Department of Medicine, Showa University School of Medicine
Kida, Takashi Infammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Matsuo, Yusuke Department of Rheumatology, Tokyo Kyosai Hospital
Nishimura, Keisuke Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine
Yamane, Takashi Department of Rheumatology, Kakogawa Central City Hospital
Abstract
Background Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection in patients undergoing immunosuppressive therapy, such as glucocorticoid (GC) medication, for systemic autoimmune diseases like systemic lupus erythematosus (SLE). Despite the confirmed effectiveness of PCP prophylaxis, its clinical administration, especially in conjunction with GC dosage, remains unclear. We aimed to describe the clinical practice of PCP prophylaxis in association with SLE in Japan, evaluate the relationship between GC dosage and PCP prophylaxis, and explore the practice patterns associated with PCP prophylaxis.
Methods This cross-sectional study used data from the Lupus Registry of Nationwide Institutions in Japan from 2016 to 2021 and included patients diagnosed with SLE. Using descriptive statistics, multivariate analysis, and decision tree analysis, we examined the prevalence of PCP prophylaxis and its association with the GC dosage.
Results Out of 1,460 patients, 21% underwent PCP prophylaxis. The frequency of prophylaxis decreased with a decrease in GC dosage. After adjusting for confounders, logistic regression revealed the odds ratio of PCP prophylaxis increased with higher prednisolone (PSL) doses: 3.7 for 5 <= PSL < 7.5 mg, 5.2 for 7.5 <= PSL < 10 mg, 9.0 for 10 <= PSL < 20 mg, and 43.1 for PSL >= 20 mg, using PSL < 5 mg as the reference. Decision tree analysis indicated that a PSL dosage of < 11 mg/day and immunosuppressant use were key determinants of PCP prophylaxis.
Conclusion This study provides valuable insights into PCP prophylaxis practices in patients with SLE in Japan, underscoring the importance of GC dosage and concomitant immunosuppressant use.
Keywords
Systemic lupus erythematosus
Pneumocystis jirovecii pneumonia
Glucocorticoid
Immunosuppressant
Practice pattern
Note
The version of record of this article, first published in Arthritis Research & Therapy, is available online at Publisher’s website: http://dx.doi.org/10.1186/s13075-024-03434-2
Published Date
2024-11-12
Publication Title
Arthritis Research & Therapy
Volume
volume26
Issue
issue1
Publisher
BMC
Start Page
198
ISSN
1478-6354
Content Type
Journal Article
language
English
OAI-PMH Set
岡山大学
Copyright Holders
© The Author(s) 2024.
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isVersionOf https://doi.org/10.1186/s13075-024-03434-2
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http://creativecommons.org/licenses/by-nc-nd/4.0/
Citation
Onishi, T., Sada, Ke., Hayashi, K. et al. Clinical practice pattern of Pneumocystis pneumonia prophylaxis in systemic lupus erythematosus: a cross-sectional study from lupus registry of nationwide institutions (LUNA). Arthritis Res Ther 26, 198 (2024). https://doi.org/10.1186/s13075-024-03434-2