Abstract
Introduction
Pneumocystis pneumonia (PCP) is an opportunistic lung infection and has been reported among patients
with rheumatoid arthritis (RA). An animal study revealed that sulfasalazine enhances
Pneumocystis clearance from the lung by accelerating macrophage activity.
Methods
The self-controlled case series (SCCS) method was used to investigate the association
between sulfasalazine use and PCP development in patients with RA without the effect
of time-invariant, interpatient confounders. PCP episodes which developed in patients
with RA at five hospitals between 2003 and 2019 were identified. PCP was defined by
the following criteria: 1) detection of Pneumocystis jirovecii in respiratory specimens by polymerase chain reaction; 2) clinical symptoms (pyrexia,
dry cough, dyspnea or hypoxia); 3) diffuse interstitial infiltrate on chest imaging;
and 4) absence of PCP prophylaxis. The PCP incidence rate ratio (IRR) was compared
between periods with and without sulfasalazine use by conditional Poisson regression.
Results
Fifty episodes of PCP were identified in 49 patients. Thirty patients received sulfasalazine
at some point during their observation. While 49 episodes of PCP developed in 170.3
person-years without sulfasalazine use, only one episode of PCP developed in 103.7
person-years with sulfasalazine use. Sulfasalazine use was associated with a decreased
PCP risk (adjusted IRR <0.01; 95% confidence interval <0.01–0.03) after adjusting
for age and glucocorticoid, methotrexate, and tumor necrosis factor inhibitor administration.
Conclusion
Our study demonstrated a preventive effect of sulfasalazine against PCP in patients
with RA.
Keywords
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Article info
Publication history
Published online: November 05, 2022
Accepted:
October 30,
2022
Received in revised form:
October 24,
2022
Received:
August 25,
2022
Identification
Copyright
© 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
