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Pneumocystis jirovecii pneumonia associated with etanercept treatment in patients with rheumatoid arthritis: a retrospective review of 15 cases and analysis of risk factors. 2012
Michi Tanaka, and
Ryoko Sakai, and
Ryuji Koike, and
Yukiko Komano, and
Toshihiro Nanki, and
Fumikazu Sakai, and
Haruhito Sugiyama, and
Hidekazu Matsushima, and
Toshihisa Kojima, and
Shuji Ohta, and
Yoji Ishibe, and
Takuya Sawabe, and
Yasuhiro Ota, and
Kazuhisa Ohishi, and
Hajime Miyazato, and
Yoshinori Nonomura, and
Kazuyoshi Saito, and
Yoshiya Tanaka, and
Hayato Nagasawa, and
Tsutomu Takeuchi, and
Ayako Nakajima, and
Hideo Ohtsubo, and
Makoto Onishi, and
Yoshinori Goto, and
Hiroaki Dobashi, and
Nobuyuki Miyasaka, and
Masayoshi Harigai
Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan.
OBJECTIVE The association of anti-tumor necrosis factor therapy with opportunistic infections in rheumatoid arthritis (RA) patients has been reported. The goal of this study was to clarify the clinical characteristics and the risk factors of RA patients who developed Pneumocystis jirovecii pneumonia (PCP) during etanercept therapy. METHODS We conducted a multicenter, case-control study in which 15 RA patients who developed PCP were compared with 74 RA patients who did not develop PCP during etanercept therapy. RESULTS PCP developed within 26 weeks following the first injection of etanercept in 86.7% of the patients. All PCP patients presented with a rapid and severe clinical course and the overall mortality was 6.7%. Independent risk factors were identified using multivariate analysis and included age ≥65 years [hazard ratio (HR) 3.35, p = 0.037], coexisting lung disease (HR 4.48, p = 0.009), and concomitant methotrexate treatment (HR 4.68, p = 0.005). In patients having a larger number of risk factors, the cumulative probability of developing PCP was significantly higher (p < 0.001 for patients with two or more risk factors vs. those with no risk factor, and p = 0.001 for patients with one risk factor vs. those with no risk factor). CONCLUSIONS Physicians must consider the possibility of PCP developing during etanercept therapy in RA patients, particularly if one or more risk factors are present.
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