PROPHYLACTIC CO-TRIMOXAZOLE PRESCRIBING PRACTICE IN PATIENTS WHO RECEIVED RITUXIMAB THERAPY: COMPARISON ACROSS INDICATIONS AND SPECIALTIES

Sherdya Worthy Tio, Juliette Morrow,Sharon Cowley,Michael Clarkson,Grainne Murphy

Rheumatology（2024）SCI 2区

Cited 0|Views7

Abstract

Background/Aims Rituximab is a chimeric anti-CD20 monoclonal antibody targeting B-cells used as part of treatment algorithms for malignancy and autoimmune diseases. As is the case of other immunosuppressive agents, rituximab increases the risk of infections. Primary prophylaxis with co-trimoxazole may be considered in high-risk cohort of patients to prevent opportunistic infection, particuarly Pneumocystis jerovecii pneumonia (PJP). To investigate the prescribing practice for prophylactic co-trimoxazole in patients who received rituximab infusion in a large tertiary referral centre. To compare practices between rheumatology and nephrology department. To compare the incidence of hospitalisation for infection (particularly PJP) between those prescribed prophylactic co-trimoxazole and those who did not. Methods This was a single centre retrospective observational study over a 3 year period assessing prophylactic co-trimoxazole prescribing practice in 185 patients attending rheumatology or renal services in Cork University Hospital (CUH) and receiving rituximab. Co-trimoxazole prophylactic treatment was defined as prophylaxis dose of co-trimoxazole (either 480mg daily or 960mg three times per week) received during rituximab treatment and at least 6 months post completion of treatment. Results 185 patients' medical charts were reviewed. Only 28 patients received prophylaxis with co-trimoxazole. The majority of patients (n=24, 85%) who received prophylaxis with co-trimoxazole had an underlying diagnosis of small vessel vasculitis (SVV). Co-trimoxazole was more commonly prescribed by nephrologists (n=17, 71% primarily for SVV) as compared to rheumatologist (n=7, 29% primarily for SVV). 156 patients were not prescribed prophylactic co-trimoxazole. The primary indication for rituximab in these patients was inflammatory arthropathy (IA) (n=72,46%), SVV (n=26, 16%), systemic lupus erythematosus (n=19, 12%), with the remainder accounted for by scleroderma, undifferentiated connective tissue disease, membranous nephropathy (MN), myositis, focal segmental glomerulosclerosis and amyloid renal disease. No patient was admitted over the course of the study period with PJP. 59 patients required hospital admissions due to other infections, most commonly patients with SVV. The most common infections were respiratory tract and urinary tract infections. Overall infections requiring hospitalization were more common in the group receiving prophylaxis, perhaps highlighting the vulnerable nature and greater prednisolone prescribing in the SVV cohort. No difference was seen between groups in the prevalence of UTIs. Conclusion In this cohort co-trimoxazole prophylaxis was more commonly prescribed for patient with small vessel vasculitis and differences in prescribing patterns were seen between nephrologists and rheumatologists. With greater awareness of the heightened risk of PJP in patents receiving rituximab consideration should be given to use of antibiotic prophylaxis for other indications. Disclosure S. Tio: None. J. Morrow: None. S. Cowley: None. M. Clarkson: None. G. Murphy: None.

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【要点】：该研究探讨了在大型三级转诊中心接受利妥昔单抗治疗的患者中，预防性使用复方新诺明的处方实践，并比较了风湿科和肾内科之间的差异以及预防性用药与感染住院率之间的关系。

【方法】：这是一项单中心回顾性观察研究，在3年时间内评估了185名在科克大学医院接受风湿科或肾科服务并接受利妥昔单抗治疗的患者中预防性使用复方新诺明的处方实践。

【实验】：研究回顾了185名患者的医疗记录。其中只有28名患者接受了预防性复方新诺明治疗，大多数（85%）患有小血管炎。复方新诺明更常由肾内科医生处方（71%主要用于小血管炎），而风湿科医生较少使用（29%主要用于小血管炎）。未接受预防性治疗的156名患者中，主要使用利妥昔单抗的指征是炎症性关节病（46%）、小血管炎（16%）、系统性红斑狼疮（12%）。在研究期间，没有患者因肺孢子菌肺炎（PJP）住院，59名患者因其他感染住院，其中最常见的是呼吸道和泌尿道感染。接受预防性治疗的患者中，需要住院的感染更常见，这或许突出了小血管炎患者群体的脆弱性和更大剂量的泼尼松使用。两组在尿路感染的发生率上没有差异。