AB0180 A MULTICENTER SELF-CONTROLLED CASE SERIES STUDY INVESTIGATING THE PREVENTIVE EFFECT OF SULFASALAZINE AGAINST PNEUMOCYSTIS PNEUMONIA
| Autor: | T. Kakutani, F. Chen, M. Tateishi, M. Kimura, Kota Shimada, T. Nunokawa, Keigo Setoguchi, M. Sugihara, N. Chinen |
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| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | Annals of the Rheumatic Diseases. 80:1115.2-1115 |
| ISSN: | 1468-2060 0003-4967 |
| Popis: | Background:An animal study revealed that sulfasalazine (SSZ) enhances Pneumocystis clearance from the lung by accelerating macrophage activity.[1] Although the preventive effect of SSZ on Pneumocystis pneumonia (PCP) in patients with rheumatoid arthritis (RA) is reported in case-control studies, some important confounders might remain unmeasured and distort the results. [2-3]. The self-controlled case series (SCCS) method involves only cases and controls fixed confounders automatically.[4]Objectives:To evaluate the prophylactic effect of SSZ against PCP in patients with RA, controlling unmeasurable confounders by the SCCS method.Methods:A retrospective study was conducted at five hospitals. Patients with RA who developed PCP between 2003 and 2019 were included. PCP was defined by the following criteria: (1) detection of Pneumocystis jirovecii in respiratory specimens by polymerase chain reaction; (2) clinical manifestations (pyrexia, dry cough, dyspnea, or hypoxia); (3) diffuse interstitial infiltrate on chest imaging; (4) absence of prophylaxis for PCP. Incidence rate ratio (IRR) for Pneumocystis pneumonia associated with sulfasalazine use was calculated by conditional Poisson regression.Results:We identified 48 episodes of PCP in 47 cases. Of these, 15 (31.9%) died. Thirty received SSZ in certain periods of their observations (Table 1). While 46 episodes of PCP developed in the period of 168.9 person-years without SSZ use, only one episode of PCP developed in the period of 103.7 person-years with SSZ use. SSZ use had a decreased risk of PJP (adjusted IRR 0.007, 95% CI Table 1.Characteristic of the 47 patients enrolled in the study.Male/female, n (%)14 (29.8)/33 (70.2)Observational period (years), median (IQR)72.0 (66.3-79.1)Lung disease, n (%)4.7 (1.4-9.5)Use of sulfasalazine, n (%)23 (48.9)Outcome of PCP, death, n (%)30 (63.8)Age at the onset of PCP (years), median (IQR)15 (31.9)PCP, Pneumocystis pneumonia; IQR, interquartile range.Table 2.Unadjusted and adjusted incidence rate ratio for Pneumocystis pneumonia associated with sulfasalazine use.Observation length (years)Episodes of PCP, n (%)Unadjusted IRR95% CI)Adjusted IRRa(% CI)Use of SSZ103.71 (2.1)0.010 (0.001-0.092)0.007 (No use of SSZ168.947 (97.9)referencereferenceIRR, incidence rate ratio; PCP, Pneumocystis pneumonia; SSZ, sulfasalazine.Conclusion:Our study demonstrated the preventive effect of SSZ against PCP with confounders controlled by the SCCS.References:[1]Wang, J., et al. Immune modulation with sulfasalazine attenuates immunopathogenesis but enhances macrophage- mediated fungal clearance during pneumocystis pneumonia. PLoS Pathog. 2010;19;6(8):e1001058.[2]Nunokawa, T. et al. Prophylactic effect of sulfasalazine against Pneumocystis pneumonia in patients with rheumatoid arthritis: A nested case-control study. Semin. Arthritis Rheum. 2019;48(4):573-578.[3]Nunokawa, T., et al. Effect of Sulfasalazine Use on the Presence of Pneumocystis Organisms in the Lung among Patients with Rheumatoid Arthritis: A Test-Negative Design Case-Control Study with PCR Tests. Mod. Rheumatol. 2019;29(3):436-440.[4]Petersen, I., et al. Self controlled case series methods: an alternative to standard epidemiological study designs. BMJ. 2016;12;354:i4515.Disclosure of Interests:None declared |
| Databáze: | OpenAIRE |
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