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The following is a summary of “Incidence of Pneumocystis jirovecii Pneumonia and Prophylaxis-Associated Adverse Events Among Patients With Systemic Lupus Erythematosus,” published in the November 2024 issue of Rheumatology by Jiang et al. 

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection in patients with systemic lupus erythematosus (SLE). 

Researchers conducted a retrospective study to describe the incidence of PJP among patients with SLE. 

They conducted a retrospective cohort analysis using the TriNetX database. Patients had ≥ 2 International Classification of Diseases, 9th or 10th revision, Clinical Modification (ICD-9/ICD-10-CM) codes for SLE, separated by ≥ 30 days, and were new users of mycophenolate mofetil (MMF) and/or cyclophosphamide (CYC). PJP incidence over the first 6 months of therapy was calculated, and adverse events (AEs) were assessed using IRR and Cox proportional hazards regressions. 

The results showed 6,017 patients with SLE, 86% female (n = 5176), and 35.5% Black or African American (n = 2138). Induction medications included MMF (n = 5208, 86.6%), CYC (n = 505, 8.4%), or both (n = 304, 5.1%), with trimethoprim-sulfamethoxazole as the most common PJP prophylaxis (n = 1126, 18.7%). Of these 5 PJP cases, over 2,752 person-years were identified (1.8 cases/1000 PYs). Prophylaxis use was associated with higher risks of neutropenia (hazard ratio [HR] 2.5, 95% CI 1.4-4.4), leukopenia (HR 1.9, 95% CI 1.3-2.8), nephropathy (HR 1.7, 95% CI 1.4-2.1), and hyperkalemia (HR 1.4, 95% CI 0.9-2.0). 

They found that PJP rarely affected patients with SLE undergoing MMF and/or CYC therapy, and prophylaxis was linked to AEs. The data did not support universal PJP prophylaxis for patients with SLE without lung disease. 

Source: jrheum.org/content/early/2024/11/25/jrheum.2023-1038