OBJECTIVE Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection that may affect patients with systemic lupus erythematosus (SLE). The objective of this project was to describe the incidence of PJP among patients with SLE. METHODS A retrospective cohort analysis of the TriNetX database was conducted. Included patients had ≥ 2 International Classification of Diseases, 9th or 10th revision, Clinical Modification (ICD-9-CM/ICD-10-CM) codes for SLE separated by at least 30 days and were new users of mycophenolate mofetil (MMF) and/or cyclophosphamide (CYC). The incidence of PJP over the first 6 months of therapy was calculated; adverse events were assessed using incidence rate ratios (IRR) and Cox proportional hazards regressions. RESULTS A total of 6017 patients with SLE were identified. Most were female (n = 5176, 86%) and Black or African American (n = 2138, 35.5%). Induction medications included MMF (n = 5208, 86.6%), CYC (n = 505, 8.4%), or both (n = 304, 5.1%); the most common PJP prophylaxis was trimethoprim-sulfamethoxazole (n = 1126, 18.7%). Five PJP cases were identified over 2752 person-years (PYs), one of whom received PJP prophylaxis, for an incidence rate of 1.8 cases/1000 PYs. In the adjusted analysis, patients who received prophylaxis had a higher risk of neutropenia (hazard ratio [HR] 2.5, 95% CI 1.4-4.4), leukopenia (HR 1.9, 95% CI 1.3-2.8), nephropathy (HR 1.7, 95% CI 1.4-2.1), and hyperkalemia (HR 1.4, 95% CI 0.9-2.0). CONCLUSION PJP rarely affects patients with SLE undergoing therapy with MMF and/or CYC; prophylaxis against PJP is associated with adverse events. The majority of patients with SLE and PJP had structural lung disease. These data do not support universal prescribing of PJP prophylaxis for patients with SLE without lung disease.

中文翻译：

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系统性红斑狼疮患者耶氏肺孢子菌肺炎的发生率和预防相关不良事件。


目的 耶氏肺孢子菌肺炎 （PJP） 是一种机会性感染，可能影响系统性红斑狼疮 （SLE） 患者。该项目的目的是描述 SLE 患者中 PJP 的发病率。方法 对 TriNetX 数据库进行回顾性队列分析。纳入的患者≥有 2 个国际疾病分类第 9 次或第 10 次修订版临床修改 （ICD-9-CM/ICD-10-CM） 代码，间隔至少 30 天，并且是吗替麦考酚酯 （MMF） 和/或环磷酰胺 （CYC） 的新使用者。计算治疗前 6 个月 PJP 的发生率;使用发病率比 （IRR） 和 Cox 比例风险回归评估不良事件。结果 共确定 6017 例 SLE 患者。大多数是女性 （n = 5176， 86%） 和黑人或非裔美国人 （n = 2138， 35.5%）。诱导药物包括 MMF （n = 5208， 86.6%）、CYC （n = 505， 8.4%） 或两者 （n = 304， 5.1%）;最常见的 PJP 预防是甲氧苄啶-磺胺甲噁唑 （n = 1126， 18.7%）。在 2752 人年 （PY） 中发现了 5 例 PJP 病例，其中 1 例接受了 PJP 预防，发病率为 1.8 例/1000 PYs。在调整后的分析中，接受预防治疗的患者发生中性粒细胞减少症 （HR 2.5,95% CI 1.4-4.4）、白细胞减少症 （HR 1.9,95% CI 1.3-2.8）、肾病 （HR 1.7,95% CI 1.4-2.1） 和高钾血症 （HR 1.4,95% CI 0.9-2.0） 的风险更高。结论 PJP 很少影响接受 MMF 和/或 CYC 治疗的 SLE 患者;预防 PJP 与不良事件相关。大多数 SLE 和 PJP 患者患有结构性肺病。这些数据不支持对无肺病的 SLE 患者进行 PJP 预防的普遍处方。