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 TakeuchiAyako Nakajima, Hideo Ohtsubo, Makoto Onishi, Yoshinori Goto, Hiroaki Dobashi, Nobuyuki Miyasaka, Masayoshi Harigai

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40 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 1

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Keywords

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

ASJC Scopus subject areas

  • Rheumatology

Cite this

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., ... 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, 22(6), 849-858. https://doi.org/10.1007/s10165-012-0615-z