Vol.23 No.6

Original Article

Clinical characteristics and risk factors for Pneumocystis jirovecii pneumonia in patients with rheumatoid arthritis receiving adalimumab: a retrospective review and case?control study of 17 patients

Authors

Kaori Watanabe1, 2 , Ryoko Sakai1, 2 , Ryuji Koike1, 2, 3 , Fumikazu Sakai4 , Haruhito Sugiyama5 , Michi Tanaka1, 2 , Yukiko Komano2 , Yuji Akiyama6 , Toshihide Mimura6 , Motohide Kaneko7 , Hitoshi Tokuda8 , Takenobu Iso9

  • Department of Pharmacovigilance, Graduate School of Medical and Dental Sciences, Tokyo Medical Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
  • Department of Medicine and Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
  • Clinical Research Center, Tokyo Medical Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
  • Department of Diagnostic Radiology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka Saitama, 350-1298, Japan
  • Department of Pulmonary Medicine, National Center for Global Health and Medicine, 1-21-1Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
  • Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, 38 Morohongou, Moroyamamachi, Irumagun Saitama, 350-0495, Japan
  • Kaneko Clinic, 305 Nishiaraijyuku, Kawaguchi Saitama, 333-0083, Japan
  • Department of Respiratory Medicine, Social Insurance Central General Hospital, 3-22-1 Hyakunin-cho, Shinjyuku-ku, Tokyo 169-0073, Japan
  • Gunma Rheumatism Clinic, 1040 Inomachi, Takasaki Gunma, 370-0004, Japan
  • Department of Respiratory Medicine, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki Gunma, 370-0829, Japan
  • Department of Allergy and Clinical Immunology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba Chiba, 260-8677, Japan
  • First Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama Toyama, 930-0194, Japan
  • Tokyo Medical and Dental University Graduate School of Health Care Sciences, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
  • Nagara Orthopaedic Clinic, 3-10-12 Yashiro, Gifu-shi Gifu, 502-0812, Japan
  • Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fucyu-shi Tokyo, 183-8524, Japan
  • Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, 3-39-15 Syowamachi, Maebashi-shi Gunma, 371-8511, Japan
  • Center for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, 1-1-1 Izumi-cho, Narashino Chiba, 275-8580, Japan
  • Rheumatic Diseases Center, Kohnan Kakogawa Hospital, 1545-1 Kanno-cho-saijyo, Kakogawa Hyogo, 675-8545, Japan
  • Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita Osaka, 565-0871, Japan
  • Sekimachi Hospital, 1-6-19 Sekimachikita, Nerima-ku, Tokyo 177-0051, Japan
  • Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo 173-8610, Japan
  • Division of Rheumatology and Allergy, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki Kanagawa, 216-8511, Japan
  • Division of Rheumatology and Clinical Immunology, Department of Medicine Sapporo City General Hospital, Kita 11-jo, Nishi-13 Chome, Chuo-ku, Sapporo 060-8604, Japan
  • Division of Rheumatology, Higashihiroshima Memorial Hospital, 2214 Saijyocyoyoshiyuki, Higashihiroshima Hiroshima, 739-0002, Japan
  • The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
  • Global Center of Excellence (GCOE) Program, International Research Center for Molecular Science in Tooth and Bone Diseases, Tokyo Medical Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
Received:

28 June 2012

Accepted:

31 October 2012

Published online:

5 December 2012

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Abstract

Abstract
Objectives To investigate the clinical characteristics and risk factors of Pneumocystis jirovecii pneumonia (PCP) in rheumatoid arthritis (RA) patients treated with adalimumab.
Methods We conducted a multicenter, retrospective, case?control study to compare RA patients treated with adalimumab with and without PCP. Data from 17 RA patients who were diagnosed with PCP and from 89 RA reatment were collected.
Results For the PCP patients, the median age was 68 years old, with a median RA disease duration of eight years. The median length of time from the first adalimumab injection to the development of PCP was 12 weeks. At the onset of PCP, the median dosages of prednisolone and methotrexate were 5.0 mg/day and 8.0 mg/week, respectively. The patients with PCP were significantly older (p \ 0.05) and had more structural changes (p \ 0.05) than the patients without PCP. Computed tomography of the chest revealed ground-glass opacity without interlobular septal boundaries in the majority of the patients with PCP. Three PCP patients died.
Conclusions PCP may occur early in the course of adalimumab therapy in patients with RA. Careful monitoring, early diagnosis, and proper management are mandatory to secure a good prognosis for these patients.

Key words

Adalimumab, Pneumocystis jirovecii pneumonia, Rheumatoid arthritis, TNF antagonist