{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T02:19:57Z","timestamp":1794277197457,"version":"4.9.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,9,14]],"date-time":"2019-09-14T00:00:00Z","timestamp":1568419200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,9,14]],"date-time":"2019-09-14T00:00:00Z","timestamp":1568419200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003653","name":"Korea National Institute of Health","doi-asserted-by":"crossref","award":["HC17C0069"],"award-info":[{"award-number":["HC17C0069"]}],"id":[{"id":"10.13039\/501100003653","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arthritis Res Ther"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n              <jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>To investigate the incidence of pneumocystis pneumonia (PCP) and its risk factors in patients with rheumatic disease receiving non-high-dose steroid treatment, along with the risks and benefits of PCP prophylaxis.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This study included 28,292 treatment episodes with prolonged (\u2265\u20094\u2009weeks), non-high-dose steroids (low dose [&lt;\u200915\u2009mg\/day, <jats:italic>n<\/jats:italic>\u2009=\u200927,227] and medium dose [\u2265\u200915 to &lt;\u200930\u2009mg\/day, <jats:italic>n<\/jats:italic>\u2009=\u20091065], based on prednisone) over a 14-year period. Risk factors for PCP and prophylactic effect of trimethoprim\u2013sulfamethoxazole (TMP-SMX) were investigated if the 1-year incidence rate (IR) of PCP in each dose group was &gt;\u20090.1\/100 person-years. Cox regression with LASSO was used for analysis.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>One-year PCP IR in the low-dose group was 0.01 (95% CI 0.001\u20130.03)\/100 person-years, and only the medium-dose group showed eligible PCP IR for further analysis. In the medium-dose group, prophylactic TMP-SMX was administered in 45 treatment episodes while other episodes involved no prophylaxis (prophylaxis group vs. control group). In 1018.0 person-years, 5 PCP cases occurred exclusively in the control group, yielding an IR of 0.5 (0.2\u20131.2)\/100 person-years. Concomitant steroid-pulse treatment and baseline lymphopenia were the most significant risk factors for PCP. Treatment episodes with at least one of these factors (<jats:italic>n<\/jats:italic>\u2009=\u2009173, high-risk subgroup) showed higher 1-year PCP IR (3.4 (1.1\u20138.0)\/100 person-years), while no PCP occurred in other treatment episodes. TMP-SMX numerically reduced the risk (adjusted HR\u2009=\u20090.2 (0.001\u20132.3)) in the high-risk subgroup. The IR of adverse drug reactions (ADRs) related to TMP-SMX was 41.5 (22.3\u201371.6)\/100 person-years, including one serious ADR. The number needed to treat with TMP-SMX to prevent one PCP in the high-risk subgroup (31 (17\u2013226)) was lower than the number needed to harm by serious ADR (45 (15\u2013\u221e)).<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Incidence of PCP in patients with rheumatic diseases receiving prolonged, medium-dose steroids depends on the presence of risk factors. Prophylactic TMP-SMX may have greater benefit than potential risk in the high-risk subgroup.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13075-019-1996-6","type":"journal-article","created":{"date-parts":[[2019,9,14]],"date-time":"2019-09-14T05:02:37Z","timestamp":1568437357000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":79,"title":["Pneumocystis pneumonia in patients with rheumatic diseases receiving prolonged, non-high-dose steroids\u2014clinical implication of primary prophylaxis using trimethoprim\u2013sulfamethoxazole"],"prefix":"10.1186","volume":"21","author":[{"given":"Jun Won","family":"Park","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey R.","family":"Curtis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Jung","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajeong","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeong Wook","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0703-1208","authenticated-orcid":false,"given":"Eun Bong","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,9,14]]},"reference":[{"issue":"24","key":"1996_CR1","doi-asserted-by":"publisher","first-page":"2487","DOI":"10.1056\/NEJMra032588","volume":"350","author":"CF Thomas Jr","year":"2004","unstructured":"Thomas CF Jr, Limper AH. 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Consent was waived by the IRB because of the retrospective nature of the study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Eun Bong Lee has acted as a consultant to Pfizer and received research grants from Green Cross Corp, outside the submitted work. Jeffrey R Curtis reports grants and personal fees from AbbVie, grants and personal fees from Amgen, grants and personal fees from BMS, grants and personal fees from Corrona, grants and personal fees from Eli Lilly, grants and personal fees from Myriad, grants and personal fees from Pfizer, grants and personal fees from Janssen, grants and personal fees from Roche, grants and personal fees from Regeneron, and grants and personal fees from UCB, outside the submitted work. The other authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"207"}}