Vol.23 No.1

Original Article

Positivity for anti-RNP antibody is a risk factor for adverse effects caused by trimethoprim?sulfamethoxazole, a prophylactic agent for P. jiroveci pneumonia, in patients with connective tissue diseases

Authors

Reika Maezawa1 , Kazuhiro Kurasawa1 , Satoko Arai1 , Harutsugu Okada1 , Takayoshi Owada1 , Takeshi Fukuda1

  • Clinical Immunology, Dokkyo Medical University, 880 Kita-Kobayashi, Mibu, Tochigi, 321-0293, Japan
Received:

24 November 2011

Accepted:

15 February 2012

Published online:

31 March 2012

Full Text

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Abstract

Objectives Trimethoprim-sulphamethoxazole (TMP-STX), an agent used for prophylaxis against pneumocystis pneumonia (PCP) in immunocompromised hosts, causes serious adverse effects (AEs) in some patients. The objective of this study was to identify the risk factors for AEs caused by TMP-STX in connective tissue disease (CTD) patients and to describe the clinical features of the AEs.
Methods The medical records of 539 patients (CTDs 312, pulmonary diseases 227) receiving TMP-STX for prophylaxis against PCP were reviewed retrospectively. Patients with human immunodeficiency virus were excluded. Univariate and multivariate analyses were conducted to identify the risk factors.
Results Adverse events caused byTMP-STXoccurred in 22 of 312 (7.05 %) CTD patients, while only six of 227 (2.64 %) pulmonary disease patients developed AEs. The incidence of AEs was significantly higher in systemic lupus erythematosus (SLE) (11.0 %) and mixed connective tissue disease (MCTD) (33.3 %) patients than in other CTD patients. AEs occurred in 25 % of patients with anti-RNP antibody. Univariate analysis revealed that SLE, MCTD, and anti-RNP antibody were risk factors for AEs in CTDpatients. Further multivariate analyses demonstrated that only anti-RNPantibody positivitywas a risk factor for AEs. Systemic inflammation, including fever, was a characteristic manifestation of the AEs in CTD patients, particularly those with anti-RNP antibody.
Conclusions Positivity for anti-RNP antibody is a risk factor for AEs caused by TMP-STX in CTD patients. Systemic inflammation, including fever, might be a characteristic feature of the AEs in CTD patients, particularly those with anti-RNP antibody.

Key words

Trimethoprim-sulfamethoxazole - Adverse effects - Anti-RNP antibody - Pneumocystis pneumonia