{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:46:00Z","timestamp":1791398760124,"version":"4.3.3"},"reference-count":36,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:00:00Z","timestamp":1746662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS\u20102023\u201000251803"],"award-info":[{"award-number":["RS\u20102023\u201000251803"]}],"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":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      Although previous studies show that primary prophylaxis against\n                      <jats:italic>Pneumocystis jirovecii<\/jats:italic>\n                      pneumonia (PJP) is effective in patients with rheumatic diseases receiving immunosuppressive treatment, there is limited evidence regarding the optimal timing for prophylaxis withdrawal. This study aimed to identify the risk factors for PJP despite prophylaxis and provide evidence for an optimal prophylaxis schedule.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This case\u2010control study included 1,294 prophylactic episodes in 1,148 patients with rheumatic disease who received immunosuppressants and prophylactic trimethoprim\u2010sulfamethoxazole (TMP\u2010SMX). The primary outcome was a one\u2010year incidence of PJP. A Cox proportional hazards model with least absolute shrinkage and selection operator was used to evaluate clinical factors associated with outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During 1,174 person\u2010years of observation, 10 cases of PJP were identified, with an incidence rate of 0.85 per 100 person\u2010years. The mean \u00b1 SD duration of TMP\u2010SMX prophylaxis was 181.9 \u00b1 128.7 days. Except in one case, PJP occurred after discontinuation of TMP\u2010SMX, with a median (interquartile range [IQR]) interval of 117.0 (86.0\u2013161.0) days. The dose of glucocorticoids at the time of TMP\u2010SMX discontinuation was significantly higher in the PJP group relative to the control group (median [IQR]: 22 [20\u201340] vs 10 [5\u201315] mg). Discontinuing TMP\u2010SMX while on a glucocorticoid dose &gt;12.5 mg\/day of prednisone equivalent significantly increased the risk of PJP (adjusted hazard ratio: 13.84; 95% confidence interval, 1.71\u2013111.80). There were 63 cases of adverse events during the observation period, and 10 (15.9%) were attributed to TMP\u2010SMX with probable causality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tapering glucocorticoids with 12.5 mg\/day of prednisone equivalent could be a reasonable timepoint to initiate the withdrawal of PJP prophylaxis in patients with rheumatic diseases.<\/jats:p>\n                    <jats:p>\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\/art43167-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.43167","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T06:10:40Z","timestamp":1743660640000},"page":"1263-1272","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Clinical Factors Associated With Pneumocystis Pneumonia Despite Its Primary Prophylaxis: When to Stop Prophylaxis?"],"prefix":"10.1002","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8982-6869","authenticated-orcid":false,"given":"Ju Yeon","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Chung\u2010Ang University Gwangmyeong Hospital  Gwangmyeong\u2010si South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Se Rim","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Rheumatology Hanyang University Hospital for Rheumatic Diseases  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2167-9393","authenticated-orcid":false,"given":"Jin Kyun","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Seoul National University College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6975-8627","authenticated-orcid":false,"given":"Eun Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Seoul National University College of Medicine  Seoul South 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 South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8624-2582","authenticated-orcid":false,"given":"Jun Won","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Seoul National University College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2009.10.010"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-96-6-705"},{"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":"10.1086\/339548"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pulmoe.2019.04.003"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/crj.13463"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1988.03720080019021"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197712292972602"},{"issue":"10","key":"e_1_2_6_10_1","article-title":"Prophylaxis for Pneumocystis pneumonia (PCP) in non\u2010HIV immunocompromised patients","volume":"2014","author":"Stern A","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/03009742.2020.1850854"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-019-1996-6"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-211796"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2011.05.004"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223335"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2023.07.012"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.111152"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keae368"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.3109\/PL00021707"},{"key":"e_1_2_6_20_1","unstructured":"Clinicalinfo.HIV.gov.Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Accessed February 2 2025.https:\/\/clinicalinfo.hiv.gov\/en\/guidelines\/adult-and-adolescent-opportunistic-infection"},{"issue":"3","key":"e_1_2_6_21_1","first-page":"490","article-title":"Guidelines for prophylaxis of Pneumocystis pneumonia cannot rely solely on CD4\u2010cell count in autoimmune and inflammatory diseases","volume":"36","author":"Baulier G","year":"2018","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1086\/515126"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.9844"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-4-42"},{"key":"e_1_2_6_25_1","unstructured":"National Cancer Institute.CTCAE Version 5.0. January 3 2018.https:\/\/evs.nci.nih.gov\/ftp1\/CTCAE\/CTCAE_5.0\/"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02799-9"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1541-0420.2008.00995.x"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-016-1324-x"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2015.11.012"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.05.558"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.11.007"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.4065\/71.1.5"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/rap\/rkaa029"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0248524"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiac.2023.09.030"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.15724"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.25222"}],"container-title":["Arthritis &amp; Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/art.43167","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T11:42:15Z","timestamp":1759923735000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/art.43167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,8]]},"references-count":36,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1002\/art.43167"],"URL":"https:\/\/doi.org\/10.1002\/art.43167","archive":["Portico"],"relation":{},"ISSN":["2326-5191","2326-5205"],"issn-type":[{"value":"2326-5191","type":"print"},{"value":"2326-5205","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,8]]},"assertion":[{"value":"2024-11-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}