{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:34:40Z","timestamp":1786977280963,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T00:00:00Z","timestamp":1692662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2021R1A2C2004874"],"award-info":[{"award-number":["2021R1A2C2004874"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      To identify a specific population of patients with rheumatic diseases receiving rituximab treatment for whom the benefit from primary prophylaxis against\n                      <jats:italic>Pneumocystis jirovecii<\/jats:italic>\n                      pneumonia (PJP) outweighs the risk of adverse events (AEs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included 818 patients treated with rituximab for rheumatic diseases, among whom 419 received prophylactic trimethoprim\/sulfamethoxazole (TMP\/SMX) with rituximab, while the remainder did not. Differences in 1\u2010year PJP incidence between the groups were estimated using Cox proportional hazards regression. Risk\u2013benefit assessment was performed in subgroups stratified according to risk factors based on the number needed to treat (NNT) to prevent 1 case of PJP and the number needed to harm (NNH) due to severe AEs. Inverse probability of treatment weighting was applied to minimize the confounding by indication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the 663.1 person\u2010years, there were 11 PJP cases, with a mortality rate of 63.6%. Concomitant use of high\u2010dose glucocorticoids (\u226530 mg\/day of prednisone or equivalent during 4\u2009weeks after rituximab administration) was the most important risk factor. The PJP incidence (per 100 person\u2010years) was 7.93 (95% confidence interval [95% CI] 2.91\u201317.25) in the subgroup receiving high\u2010dose glucocorticoids compared with 0.40 (95% CI 0.01\u20132.25) in the subgroup without high\u2010dose glucocorticoid use. Although prophylactic TMP\/SMX significantly reduced the overall PJP incidence (HR 0.11 [95% CI 0.03\u20130.43]), the NNT to prevent 1 case of PJP (146) was higher than the NNH (86). In contrast, the NNT fell to 20 (95% CI 10.7\u201365.7) in patients receiving concomitant high\u2010dose glucocorticoids.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The benefit associated with primary PJP prophylaxis outweighs the risk of severe AEs in patients with rheumatic diseases receiving rituximab and concomitant high\u2010dose glucocorticoid treatment.\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/art42541-toc-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/art.42541","type":"journal-article","created":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T04:14:21Z","timestamp":1682396061000},"page":"2036-2044","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Risk\u2013Benefit Analysis of Primary Prophylaxis Against\n                    <i>Pneumocystis Jirovecii<\/i>\n                    Pneumonia in Patients With Rheumatic Diseases Receiving Rituximab"],"prefix":"10.1002","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8624-2582","authenticated-orcid":false,"given":"Jun Won","family":"Park","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Seoul National University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8907-8976","authenticated-orcid":false,"given":"Jeffrey R.","family":"Curtis","sequence":"additional","affiliation":[{"name":"Division of Clinical Immunology &amp; Rheumatology University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Se Rim","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Seoul National University Bundang Hospital  Seongnam\u2010si, Gyeonggi\u2010do Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Jung","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Seoul Metropolitan Government\u2010Seoul National University, Boramae Medical Center  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"You\u2010Jung","family":"Ha","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Seoul National University Bundang Hospital  Seongnam\u2010si, Gyeonggi\u2010do Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9697-1159","authenticated-orcid":false,"given":"Eun Ha","family":"Kang","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Seoul National University Bundang Hospital  Seongnam\u2010si, Gyeonggi\u2010do Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7615-8611","authenticated-orcid":false,"given":"Yun Jong","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, and Division of Rheumatology, Department of Internal Medicine Seoul National University Bundang Hospital  Seongnam\u2010si, Gyeonggi\u2010do Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0703-1208","authenticated-orcid":false,"given":"Eun Bong","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, and Department of Molecular Medicine and Biopharmaceutical Sciences Graduate School of Convergence Science and Technology, Seoul National University  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,22]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1903.121151"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-021-06144-1"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2022.100400"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-212588"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-211796"},{"key":"e_1_2_6_7_1","first-page":"671","article-title":"Pneumocystis jiroveci pneumonia in rheumatic disease: a 20\u2010year single\u2010centre experience","volume":"35","author":"Mecoli CA","year":"2017","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.02639-14"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.178.10.6604"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.11.007"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02799-9"},{"key":"e_1_2_6_12_1","unstructured":"US Department of Health and Human Services.Common terminology criteria for adverse events (CTCAE) version 5.0. 2017. 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