Pneumocystis jirovecii pneumonia associated with etanercept treatment in patients with rheumatoid arthritis

A retrospective review of 15 cases and analysis of risk factors

Michi Tanaka, Ryoko Sakai, Ryuji Koike, Yukiko Komano, Toshihiro Nanki, Fumikazu Sakai, Haruhito Sugiyama, Hidekazu Matsushima, Toshihisa Kojima, Shuji Ohta, Yoji Ishibe, Takuya Sawabe, Yasuhiro Ota, Kazuhisa Ohishi, Hajime Miyazato, Yoshinori Nonomura, Kazuyoshi Saito, Yoshiya Tanaka, Hayato Nagasawa, Tsutomu Takeuchi & 7 others Ayako Nakajima, Hideo Ohtsubo, Makoto Onishi, Yoshinori Goto, Hiroaki Dobashi, Nobuyuki Miyasaka, Masayoshi Harigai

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objectives 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). Conclusion Physicians must consider the possibility of PCP developing during etanercept therapy in RA patients, particularly if one or more risk factors are present.

Original languageEnglish
Pages (from-to)849-858
Number of pages10
JournalModern Rheumatology
Volume22
Issue number6
DOIs
Publication statusPublished - 2012 Nov

Fingerprint

Pneumocystis carinii
Pneumocystis Pneumonia
Rheumatoid Arthritis
Therapeutics
Etanercept
Opportunistic Infections
Methotrexate
Lung Diseases
Case-Control Studies
Multivariate Analysis
Tumor Necrosis Factor-alpha
Physicians

Keywords

  • Anti-TNF therapy
  • Etanercept
  • Opportunistic infection
  • Pneumocystis jirovecii pneumonia
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology

Cite this

Pneumocystis jirovecii pneumonia associated with etanercept treatment in patients with rheumatoid arthritis : A retrospective review of 15 cases and analysis of risk factors. / Tanaka, Michi; Sakai, Ryoko; Koike, Ryuji; Komano, Yukiko; Nanki, Toshihiro; Sakai, Fumikazu; Sugiyama, Haruhito; Matsushima, Hidekazu; Kojima, Toshihisa; Ohta, Shuji; Ishibe, Yoji; Sawabe, Takuya; Ota, Yasuhiro; Ohishi, Kazuhisa; Miyazato, Hajime; Nonomura, Yoshinori; Saito, Kazuyoshi; Tanaka, Yoshiya; Nagasawa, Hayato; Takeuchi, Tsutomu; Nakajima, Ayako; Ohtsubo, Hideo; Onishi, Makoto; Goto, Yoshinori; Dobashi, Hiroaki; Miyasaka, Nobuyuki; Harigai, Masayoshi.

In: Modern Rheumatology, Vol. 22, No. 6, 11.2012, p. 849-858.

Research output: Contribution to journalArticle

Tanaka, M, Sakai, R, Koike, R, Komano, Y, Nanki, T, Sakai, F, Sugiyama, H, Matsushima, H, Kojima, T, Ohta, S, Ishibe, Y, Sawabe, T, Ota, Y, Ohishi, K, Miyazato, H, Nonomura, Y, Saito, K, Tanaka, Y, Nagasawa, H, Takeuchi, T, Nakajima, A, Ohtsubo, H, Onishi, M, Goto, Y, Dobashi, H, Miyasaka, N & Harigai, M 2012, 'Pneumocystis jirovecii pneumonia associated with etanercept treatment in patients with rheumatoid arthritis: A retrospective review of 15 cases and analysis of risk factors', Modern Rheumatology, vol. 22, no. 6, pp. 849-858. https://doi.org/10.1007/s10165-012-0615-z
Tanaka, Michi ; Sakai, Ryoko ; Koike, Ryuji ; Komano, Yukiko ; Nanki, Toshihiro ; Sakai, Fumikazu ; Sugiyama, Haruhito ; Matsushima, Hidekazu ; Kojima, Toshihisa ; Ohta, Shuji ; Ishibe, Yoji ; Sawabe, Takuya ; Ota, Yasuhiro ; Ohishi, Kazuhisa ; Miyazato, Hajime ; Nonomura, Yoshinori ; Saito, Kazuyoshi ; Tanaka, Yoshiya ; Nagasawa, Hayato ; Takeuchi, Tsutomu ; Nakajima, Ayako ; Ohtsubo, Hideo ; Onishi, Makoto ; Goto, Yoshinori ; Dobashi, Hiroaki ; Miyasaka, Nobuyuki ; Harigai, Masayoshi. / Pneumocystis jirovecii pneumonia associated with etanercept treatment in patients with rheumatoid arthritis : A retrospective review of 15 cases and analysis of risk factors. In: Modern Rheumatology. 2012 ; Vol. 22, No. 6. pp. 849-858.
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abstract = "Objectives 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). Conclusion 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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T1 - Pneumocystis jirovecii pneumonia associated with etanercept treatment in patients with rheumatoid arthritis

T2 - A retrospective review of 15 cases and analysis of risk factors

AU - Tanaka, Michi

AU - Sakai, Ryoko

AU - Koike, Ryuji

AU - Komano, Yukiko

AU - Nanki, Toshihiro

AU - Sakai, Fumikazu

AU - Sugiyama, Haruhito

AU - Matsushima, Hidekazu

AU - Kojima, Toshihisa

AU - Ohta, Shuji

AU - Ishibe, Yoji

AU - Sawabe, Takuya

AU - Ota, Yasuhiro

AU - Ohishi, Kazuhisa

AU - Miyazato, Hajime

AU - Nonomura, Yoshinori

AU - Saito, Kazuyoshi

AU - Tanaka, Yoshiya

AU - Nagasawa, Hayato

AU - Takeuchi, Tsutomu

AU - Nakajima, Ayako

AU - Ohtsubo, Hideo

AU - Onishi, Makoto

AU - Goto, Yoshinori

AU - Dobashi, Hiroaki

AU - Miyasaka, Nobuyuki

AU - Harigai, Masayoshi

PY - 2012/11

Y1 - 2012/11

N2 - Objectives 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). Conclusion Physicians must consider the possibility of PCP developing during etanercept therapy in RA patients, particularly if one or more risk factors are present.

AB - Objectives 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). Conclusion Physicians must consider the possibility of PCP developing during etanercept therapy in RA patients, particularly if one or more risk factors are present.

KW - Anti-TNF therapy

KW - Etanercept

KW - Opportunistic infection

KW - Pneumocystis jirovecii pneumonia

KW - Rheumatoid arthritis

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