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Abstract: SA-PO874

Pneumocystis jirovecii Pneumonia Prophylaxis in Patients with ANCA Vasculitis on Rituximab Maintenance Therapy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Aqeel, Faten, Johns Hopkins University, Baltimore, Maryland, United States
  • Le, Dustin, Johns Hopkins University, Baltimore, Maryland, United States
  • Geetha, Duvuru, Johns Hopkins University, Baltimore, Maryland, United States
Background

Although an increased risk of Pneumocystis jirovecii pneumonia (PJP) has been reported in adults receiving rituximab, current evidence is lacking on the utility of PJP prophylaxis in AAV patients on maintenance rituximab therapy.

Methods

We performed an observational, single-center, retrospective study examining outcomes of patients with AAV on rituximab maintenance therapy with and without PJP prophylaxis. We included patients that were followed in our center from 6/1/2009-4/1/2023. Outcomes included PJP prophylaxis use, PJP infections, infections requiring hospitalizations, death, and end-stage kidney disease (ESKD). Outcomes were analyzed using T test, Fisher exact test, univariate, and multivariate logistic regression as appropriate.

Results

A total of 129 patients were included. The mean (SD) age was 62.5 (±16) years old and the mean (SD) follow-up was 7.2 (±5.4) years. 44% of patients received PJP prophylaxis, whereas 56% of patients did not. Trimethoprim-Sulfamethoxazole was used in 31% of patients, followed by Dapsone (7%), and Atovaquone (6%). In the PJP prophylaxis group, the mean (SD) duration of rituximab therapy was 3.6 (±2.5) years, and the mean (SD) prednisone dose was 0.66 mg (±1.87). In patients who did not receive PJP prophylaxis, the mean (SD) duration of rituximab therapy was 3.1 (±2.1) years, and the mean (SD) prednisone dose was 1.13 mg (±2.47). There were no PJP infections in the entire cohort. Lung involvement was associated with increased odds of PJP prophylaxis prescription (OR 4.09 [95% CI 1.8-9.82]). CD4 count <200 cells/mm3 (n=5) and serum IgG level <500 mg/dL (n=32) were not associated with higher odds of PJP prophylaxis prescription (p=0.99 and p=0.08, respectively). PJP prophylaxis did not decrease infection rates requiring hospitalizations, ESKD, or death. Corticosteroid use was associated with increased rates of infections requiring hospitalizations (OR 5.75 [95% CI 2.00-16.92]) and death (OR 4.49 [95% CI 1.26-15.82]) even after adjustment for age, gender, and PJP prophylaxis use.

Conclusion

Regardless of use of PJP prophylaxis, PJP pneumonia was not observed in AAV patients receiving maintenance rituximab therapy. AAV patients with lung involvement were more likely to be on PJP prophylaxis. Additional studies are needed to confirm these findings to guide PJP prophylaxis use in AAV patients.