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. Included patients had ≥2 ICD9- CM/ICD10-CM codes for SLE separated by at least 30 days and were new users of mycophenolate mofetil or cyclophosphamide. The incidence of PJP over the first six months of therapy was calculated; adverse events were assessed using incident rate ratios (IRR) and Cox proportional hazards regressions. RESULTS A total of 6,017 patients with SLE were identified. Most were female (5,176, 86%) and Black or African American (2,138, 35.5%). Induction medications included mycophenolate mofetil (5,208, 86.6%), cyclophosphamide (505, 8.4%), or both (304, 5.1%); the most common PJP prophylaxis was trimethoprim/sulfamethoxazole (1,126, 18.7%). Five PJP cases were identified over 2,752 person years, one of whom received PJP prophylaxis, for an incidence rate of 1.8 cases per 1000 person years. In adjusted analysis, patients who received prophylaxis had a higher risk of neutropenia (hazard ratio (HR) 2.5, CI 1.4-4.4), leukopenia (HR 1.9, CI 1.3-2.8), nephropathy (HR 1.7, CI 1.4-2.1), and hyperkalemia (HR 1.4, CI 0.9-2.0). CONCLUSION PJP rarely affects patients with SLE undergoing therapy with mycophenolate mofetil or cyclophosphamide; 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：

---

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 TriNetX 数据库的回顾性队列分析。纳入的患者有 ≥2 个 ICD9-CM/ICD10-CM 代码用于 SLE，间隔至少 30 天，并且是吗替麦考酚酯或环磷酰胺的新使用者。计算治疗前 6 个月 PJP 的发生率;使用事故率比 （IRR） 和 Cox 比例风险回归评估不良事件。结果 共确定 6,017 例 SLE 患者。大多数是女性 （5,176， 86%） 和黑人或非裔美国人 （2,138， 35.5%）。诱导药物包括吗替麦考酚酯 （5,208， 86.6%） 、环磷酰胺 （505， 8.4%） 或两者 （304， 5.1%）;最常见的 PJP 预防是甲氧苄啶/磺胺甲噁唑 （1,126， 18.7%）。在 2,752 人年中发现了 5 例 PJP 病例，其中 1 例接受了 PJP 预防，发病率为 1.8 例/1000 人年。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 （风险比 （HR） 2.5，CI 1.4-4.4）、白细胞减少症 （HR 1.9，CI 1.3-2.8）、肾病 （HR 1.7，CI 1.4-2.1） 和高钾血症 （HR 1.4，CI 0.9-2.0）。结论 PJP 很少影响接受吗替麦考酚酯或环磷酰胺治疗的 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。