A Feasibility Study Assessing Tolerability of Daily versus Twice Weekly Trimethoprim-Sulfamethoxazole Regimen for Prophylaxis against Pneumocystis Pneumonia in Patients with Systemic Autoimmune Diseases on Glucocorticoid Therapy
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概要
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Objective: To determine the feasibility of low-dose, intermittent administration of trimethoprim-sulfamethoxazole (TMP/SMX) for prophylaxis against pneumocystis pneumonia (PCP) in patients with systemic autoimmune diseases receiving medium- to high-dose glucocorticoid therapy.Methods: A randomized prospective study was performed. Patients who were scheduled to receive medium- to high-dose glucocorticoid therapy were selected and randomly allocated to one of two groups: one group received 1 tablet of TMP/SMX (TMP 80 mg and SMX 400 mg) daily and the other group received 1 tablet twice a week. The observation period was up to one year, or until the prophylactic therapy was discontinued because of steroid tapering or occurrence of adverse events (AEs). The endpoint was occurrence of PCP, and safety was also assessed.Results: Thirty-seven patients were enrolled in this study, with 19 patients assigned to the daily regimen and 18 to the twice weekly regimen. One patient in each group withdrew before starting treatment. None of the patients who entered this study developed PCP. Safety analysis showed fewer AEs with the twice weekly regimen than with the daily regimen (5 of 17 patients (29.4%) vs. 10 of 18 patients (55.6%), p＝0.176).Conclusion: From this pilot study, twice weekly TMP/SMX prophylaxis seems to be more tolerable than daily dosing in patients with systemic autoimmune diseases receiving medium- to high-dose glucocorticoid therapy. Since the number of patients was insufficient, further study is necessary to determine the optimal regimen for PCP prevention in these patients.
- 一般社団法人 日本臨床薬理学会の論文
著者
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Endo Hirahito
Division Of Rheumatology Department Of Internal Medicine Toho University School Of Medicine
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Kaneko Kaichi
Division Of Rheumatology Department Of Internal Medicine Toho University School Of Medicine
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Kusunoki Yoshie
Division Of Rheumatology Department Of Internal Medicine Toho University School Of Medicine
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Hasunuma Tomoko
Division Of Rheumatology Immunology And Genetic Program Institute Of Medical Science St. Marianna Un
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Kaburaki Makoto
Division Of Rheumatology Department Of Internal Medicine Toho University School Of Medicine
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Muraoka Sei
Division Of Rheumatology Department Of Internal Medicine Toho University School Of Medicine
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Yamamoto Tatsuhiro
Division Of Rheumatology Department Of Internal Medicine Toho University School Of Medicine
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Kawai Shinichi
Division Of Rheumatology Department Of Internal Medicine (omori) School Of Medicine Faculty Of Medicine
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Tanaka Nahoko
Division Of Rheumatology Department Of Internal Medicine (omori) School Of Medicine Faculty Of Medicine
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TAKAGI Kenji
Division of Material Science, Graduate School of Science and Engineering, Saitama University
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KITAHARA Kanako
Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine
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SHIKANO Kotaro
Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine
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AKIMOTO Kimiko
Ikebukuro Naika Clinic
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- A Feasibility Study Assessing Tolerability of Daily versus Twice Weekly Trimethoprim-Sulfamethoxazole Regimen for Prophylaxis against Pneumocystis Pneumonia in Patients with Systemic Autoimmune Diseases on Glucocorticoid Therapy
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