open access

https://hdl.handle.net/2115/97912

Sulfasalazine as a Prophylactic for Pneumocystis Pneumonia in Patients With Rheumatoid Arthritis : A Cohort Study

英語

Sulfasalazine

2025-06-16

John Wiley & Sons

International journal of rheumatic diseases

28(6)

e70325

Aim We investigated the potential of sulfasalazine (SSZ), one of the conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), as primary prophylaxis for pneumocystis pneumonia (PCP) in patients with rheumatoid arthritis (RA). Methods In this longitudinal cohort study, we enrolled patients with RA who started receiving new RA treatment. A treatment episode was defined as a period of 1 year from the start or increase of DMARDs dose, or starting prednisolone > 10 mg/day, and the incidence of PCP in this period was assessed. All treatment episodes were classified into two groups based on the presence of SSZ at baseline. The PCP incidence rate in the two groups was evaluated using a negative binomial regression model. Results A total of 848 treatment episodes were recorded in 594 RA patients: 181 and 667 in the SSZ and control groups, respectively. During the 850.6 person-years of observation, 21 patients developed PCP, and three died of PCP. Multivariable adjusted analysis using Firth's method showed that the 1-year incidence of PCP was significantly reduced with SSZ treatment (p = 0.003, rate ratio = 0.05; 95% CI 0.00-0.34). Furthermore, the log-rank test in the propensity score-matched population confirmed this result. Regarding safety, 45 adverse drug reactions related to SSZ occurred (4.34/100 person-years; 95% CI 3.26-5.78). Only one serious adverse reaction (drug-induced hypersensitivity syndrome) was observed, which resolved after discontinuation of SSZ. Conclusion We demonstrated the preventive efficacy of SSZ on PCP. The pleiotropic effect of this traditional DMARD may impact RA treatment, providing another option for PCP prophylaxis.

学術雑誌論文

Accepted Manuscript

This is the peer reviewed version of the following article: M. Yoshimura, N. Abe, M. Kono, et al., “ Sulfasalazine as a Prophylactic for Pneumocystis Pneumonia in Patients With Rheumatoid Arthritis: A Cohort Study” International Journal of Rheumatic Diseases 28, no. 6 (2025): e70325, which has been published in final form at https://doi.org/10.1111/1756-185X.70325. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.

1756-1841