July 26, 2019
2 min read

Pneumocystis pneumonia prophylaxis guidelines would be ‘helpful,’ ID docs say

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A survey of infectious disease clinicians showed there is “little consensus” regarding Pneumocystis pneumonia prophylaxis for patients with connective tissue diseases and that guidelines would be “helpful,” researchers reported.

The risk for opportunistic infections, including Pneumocystis pneumonia, increases with the use of immunosuppressive therapy for connective tissue diseases, Rachel M. Wolfe, MD, assistant professor of rheumatology and immunology at the Wake Forest School of Medicine, and colleagues noted. Pneumocystis pneumonia occurs with “varying frequencies” among immunocompromised patients without HIV, and it is “particularly associated with significant mortality in patients with underlying [connective tissue diseases (CTD)],” they wrote.

“High mortality rates are reported in CTD patients with [Pneumocystis pneumonia] which suggests a potential need for prophylaxis but indications remain poorly defined,” they wrote. “Wide variations in the use of PCP prophylaxis among rheumatologists have been documented.”

The researchers sent an electronic survey to 1,264 infectious disease physicians in the Infectious Disease Society of America Emerging Infections Network and received responses from 631. The respondents were more likely to work in academics (P = .02) and to be in their career for less than 5 years or for 25 years or more (P = .0002).

According to the survey, 43% of respondents said they made no recommendations for Pneumocystis pneumonia prophylaxis in patients without HIV. Of the respondents who did make recommendations, 53% said they recommended prophylaxis for granulomatosis with polyangiitis, the “greatest consensus for disease-based prophylaxis.” Additionally, 87% recommended 20 mg per day or more of corticosteroids, the “highest cited indication” for therapy-based prophylaxis. The researchers noted that only 21% of respondents said they used surrogate laboratory markers to aid in decisions about prophylaxis.

They reported that 65% of respondents recommended discontinuation of prophylaxis with tapering of corticosteroids, but the specific doses used were varied.

According to the researchers, 89% of respondents said Pneumocystis pneumonia prophylaxis guidelines would be “helpful.”

“Although trends in practice patterns in [Pneumocystis pneumonia] prophylaxis in CTDs can be mined from this survey, overall, there is minimal consensus on if and when prophylaxis should be recommended and what factors (disease, treatment regimen, laboratory values) should influence that decision,” the researchers wrote. “Guidelines for [Pneumocystis pneumonia] prophylaxis would provide an important adjunct in caring for complex immunosuppressed patients with underlying rheumatologic disorders.” – by Marley Ghizzone

Disclosures: Wolfe reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.