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

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Abstract

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, I2 = 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, I2 = 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.

Key Points

• We demonstrated that the combined use of glucocorticoid with other immunosuppressants increased the risk of PCP in AIID patients and resulted in poorer prognoses.

• As there are no standard prophylactic guidelines, we wish this work will be evidence to guide clinical prophylaxis.

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Acknowledgements

We thank Fan Zhang at Chongqing Medical University of China for help with literature searching and Yuhang Chen at the Chengdu University of Information Technology of China for his statistical assistance.

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  1. Hu-Yu Wang and Li-Li Shui contributed equally to this work.

Authors and Affiliations

  1. Department of Chongqing Medical University, Chongqing, 400016, China

    Huyu Wang & Yajuan Chen

  2. Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Lili Shui & Yajuan Chen

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Correspondence to Yajuan Chen.

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Wang, H., Shui, L. & Chen, Y. Combine use of glucocorticoid with other immunosuppressants is a risk factor for Pneumocystis jirovecii pneumonia in autoimmune inflammatory disease patients: a meta-analysis. Clin Rheumatol 42, 269–276 (2023). https://doi.org/10.1007/s10067-022-06381-y

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