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Response to: ‘Risk of severe infection following rituximab and the efficacy of antimicrobial prophylaxis’ by Wallace et al

Published on Jan 30, 2019in Annals of the Rheumatic Diseases14.299
· DOI :10.1136/annrheumdis-2019-215036
Andreas Kronbichler15
Estimated H-index: 15
,
Julia Kerschbaum9
Estimated H-index: 9
Abstract
We thank Dr Wallace et al for their response to our recently published article ‘Trimethoprim–sulfamethoxazole prophylaxis prevents severe/life-threatening infections following rituximab in antineutrophil cytoplasm antibody-associated vasculitis’, highlighting some methodological limitations of our study.1 2 One of the limitations mentioned by Wallace and colleagues is the inclusion of incident and prevalent cases and since only 15 out of 192 patients were incident cases, generalisability of our findings for this subset of patients may not be possible. We agree that the use of immunosuppression prior to initiation of rituximab likely confers a risk to develop infectious complications after rituximab administration. Cyclophosphamide was used to control disease in 62 patients the year before rituximab was initiated. Among these, 53 patients had no severe infection (median cyclophosphamide exposure 7 g, range 0.66–45 g), while 9 patients receiving cyclophosphamide the index year before had a severe infection following rituximab (median cyclophosphamide exposure 4.8 g, range 0.8–10 g). While this argues against an immediate impact of cyclophosphamide before rituximab on the risk of severe infections (53/143 with no severe infection against 9/49 with infection received …
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#1Zachary S. WallaceH-Index: 18
#2Hyon K. ChoiH-Index: 85
Last. John H. Stone (Harvard University)H-Index: 70
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We read with interest the article ‘Trimethoprim–sulfamethoxazole prophylaxis prevents severe/life-threatening infections following rituximab in antineutrophil cytoplasm antibody-associated vasculitis’ by Kronbichler et al .1 Severe infections continue to be a significant cause of morbidity and mortality in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), and we commend the authors for pursuing this study. However, we have several concerns regarding their methodolog...
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Objective We aimed to assess risk factors for the development of severe infection in patients with antineutrophil cytoplasm antibody-associated vasculitis (AAV) receiving rituximab. Methods 192 patients with AAV were identified. Univariate and multivariate analyses were performed to identify risk factors for severe infection following rituximab. Severe infections were classified as grade ≥3 as proposed by the Common Terminology Criteria for Adverse Events V.4.0. Results 95 severe infections were...
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Objectives To investigate the efficacy and safety of trimethoprim/sulfamethoxazole (TMP-SMX) as primary prophylaxis for pneumocystis pneumonia (PCP) in patients with rheumatic diseases receiving high-dose steroids. Methods The study included 1522 treatment episodes with prolonged (≥4 weeks) high-dose (≥30 mg/day prednisone) steroids in 1092 patients over a 12-year period. Of these, 262 treatment episodes involved TMP-SMX (prophylaxis group) while other episodes involved no prophylaxis (control g...
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We thank Dr Novikov et al for their letter on the risk of infections of patients with antineutrophil cytoplasm antibody (ANCA)-associated vasculitis and the proposed beneficial effects of hydroxychloroquine (HCQ) to reduce severe infections, as a response to our recently published article ‘Trimethoprim-sulfamethoxazole prophylaxis prevents severe/life-threatening infections following rituximab in antineutrophil cytoplasm antibody-associated vasculitis’.1 2 Modern therapies and adoption of treatm...
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