Combine use of glucocorticoid with other immunosuppressants is a risk factor for Pneumocystis jirovecii pneumonia in autoimmune inflammatory disease patients: a meta-analysis

作者全名："Wang, Huyu; Shui, Lili; Chen, Yajuan"

作者地址："[Wang, Huyu; Chen, Yajuan] Dept Chongqing Med Univ, Chongqing 400016, Peoples R China; [Shui, Lili; Chen, Yajuan] Chongqing Med Univ, Dept Resp & Crit Care Med, Affiliated Hosp 1, Chongqing 400016, Peoples R China"

通信作者："Chen, YJ (通讯作者)，Dept Chongqing Med Univ, Chongqing 400016, Peoples R China.; Chen, YJ (通讯作者)，Chongqing Med Univ, Dept Resp & Crit Care Med, Affiliated Hosp 1, Chongqing 400016, Peoples R China."

来源：CLINICAL RHEUMATOLOGY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000857286200003

JCR分区：Q3

影响因子：3.4

年份：2022

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：Autoimmune inflammatory disease; Glucocorticoid; Immunosuppressant; Pneumocystis jirovecii pneumonia; Trimethoprim and sulfamethoxazole

摘要："Objective To determine whether the combined use of glucocorticoid with other immunosuppressants increased the risk of Pneumocystis jirovecii pneumonia (PCP) in autoimmune inflammatory disease (AIID) patients. Methods The data were collected from the PubMed, Cochrane Library, and Web of Science databases. We excluded HIV-infected patients and those < 16 years of age, and included patients who combined use of glucocorticoid with other immunosuppressants or used glucocorticoid alone. The number of patients who were affected by PCP after therapy as the primary outcome and the number of patients with fatal outcomes, which included death, endotracheal tube intubation, PO2 < 60 mmHg, and other serious clinical symptoms due to PCP, as the secondary outcome. Odds ratios with 95% confidence intervals and variance tests were used to analyze the data. Results The outcomes showed that the combined use of glucocorticoid with other immunosuppressants increased the risk of PCP in AIID patients (odds ratio = 2.85, 95% confidence intervals 1.75 to 4.64, I-2 = 0%, P < 0.0001), which may be a consequence of the drug regimen reducing the lymphocyte count. Furthermore, the prognosis of patients receiving this drug regimen was poorer than with glucocorticoid alone (odds ratio = 2.31, 95% confidence intervals 1.02 to 5.23, I-2 = 0%, P = 0.04). Conclusion The combined use of glucocorticoid with other immunosuppressants increased the risk of PCP in AIID patients and resulted in poorer prognoses. It is therefore clear that appropriate prophylaxis was vital in AIID patients to minimize the risk of PCP."

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