Low Rate of PJP With ANCA-Associated Vasculitis Treatment

In patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, incidence rates of Pneumocystis jiroveci pneumonia (PJP) during induction and maintenance therapy were 15.0 and 2.1 cases per 1000 patient-years, respectively, according to study findings published online ahead of print in Arthritis Care & Research.

The study included 1461 patients with ANCA-associated vasculitis who initiated treatment with rituximab or cyclophosphamide between 2011 and 2022. Researchers looked at the incidence of PJP during the first 6 months of induction therapy with rituximab and/or cyclophosphamide, as well as during postinduction maintenance therapy with rituximab.

During induction therapy, 69.7% of patients received rituximab, 18.9% received cyclophosphamide, and 11.4% received both medications. In addition, 30.7% of patients were prescribed trimethoprim-sulfamethoxazole, 5.4% atovaquone, 3.8% dapsone, and 0.8% pentamidine within 30 days of induction for PJP prophylaxis.

A total 10 cases of PJP occurred during induction therapy, for an incidence rate of 15 cases per 1000 patient-years. All patients survived, according to the study.

Among 709 patients who received rituximab maintenance therapy, 5 cases of PJP occurred, for an incidence rate of 2.1 cases per 1000 person years. One patient died during hospitalization for PJP.

Patients prescribed PJP prophylaxis had a higher risk of leukopenia, rash, and nephropathy than patients not prescribed prophylaxis, the study found.

“Rates of PJP in ANCA-associated vasculitis patients were lower than previously observed and few cases occurred during rituximab maintenance therapy,” wrote corresponding author Elizabeth Nettleton, DO, of the Medical College of Wisconsin, Milwaukee, Wisconsin, and study coauthors. “PJP prophylaxis was associated with adverse events.”

Reference
Nettleton E, Sattui SE, Wallace Z, Putman M. Incidence of Pneumocystis jiroveci pneumonia in patients with ANCA-associated vasculitis initiating therapy with rituximab or cyclophosphamide. Arthritis Care Res. Published online August 29, 2023. doi:10.1002/acr.25222