Dr. Kronbichler and colleagues say their study confirms “a protective effect of prophylactic trimethoprim-sulfamethoxazole use on the risk to develop severe infections. Thus it may be appropriate to conclude that trimethoprim-sulfamethoxazole may reduce P. jirovecii pneumonia and also reduces overall infective risk and prophylaxis should be initiated when patients with AAV receive rituximab. … While these results require confirmation, they support routine use of trimethoprim-sulfamethoxazole in rituximab-treated patients,” they say.
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Dr. Kronbichler notes an overall reduction of severe infections of 70% was seen among those who received trimethoprim-sulfamethoxazole compared with those who did not receive prophylaxis in the study. “In general, antibiotic prophylaxis is not capable of reducing infections to zero, as we have learned in the cyclophosphamide era, because infectious complications—including severe cases—have been reported frequently.”
Additional research is underway to understand the occurrence of infections in patients with AAV who are treated with rituximab. Dr. Kronbichler explains, “We will learn about the influence of steroids from the ADVOCATE study, which is comparing Avacopan without steroids against steroids, alongside rituximab or cyclophosphamide. Specific associations, especially lung involvement, may influence infectious risk. There is clearly a need to have more reports on this issue, and international collaborations to highlight the importance of lung involvement are on their way.”
Kathy Holliman, MEd, has been a medical writer and editor since 1997.
- Kronbichler A, Kerschbaum J, Gopaluni S, et al. Trimethoprim-sulfamethoxazole prophylaxis prevents severe/life-threatening infections following rituximab in antineutrophil cytoplasm antibody-associated vasculitis. Ann Rheum Dis. 2018 Jun 27. pii: annrheumdis-2017-212861.
- Stone JH, Merkel PA, Spiera R, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med. 2010 Jul 15;363(3):221–232.
- Jones RB, Tervaert JW, Hauser T, et al. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N Engl J Med. 2010 Jul 15;363(3):211–220.