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Correspondence |

Routine Pneumocystis Pneumonia Prophylaxis in Patients Treated With Rituximab?Pneumocystis Pneumonia Prophylaxis and Rituximab FREE TO VIEW

Emilio Besada, MD
Author and Funding Information

From the Bone and Joint Research Group, Institute of Clinical Medicine, University of Tromsø.

Correspondence to: Emilio Besada, MD, Rheumatology Department, University Hospital North Norway, Postboks 14, 9038 Tromsø, Norway; e-mail: emilio.besada@unn.no


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Besada has received travel grants from Hoffmann-La Roche Inc.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(1):359-360. doi:10.1378/chest.13-0530
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To the Editor:

I was pleased to read the article by Martin-Garrido et al1 in this issue of CHEST (see page 258) on Pneumocystis pneumonia (PcP) risk in patients treated with rituximab at the Mayo Clinic in Rochester, Minnesota, from 1998 to 2011. Thirty of 230 patients with PcP had received rituximab, compared with 23 patients with HIV-associated PcP.1 However, to determine the incidence of PcP in patients treated with rituximab, I would like to know how many patients were treated with rituximab during the study period.

A systematic review and meta-analysis of randomized controlled trials recommended PcP prophylaxis in patients without HIV infection when the risk for PcP is >3.5%.2 In transplantation medicine, routine PcP prophylaxis is used in patient groups with a fixed, high incidence of disease >3% to 5%.3

PcP incidence in patients treated with rituximab is, therefore, of clinical importance to assess the risk-benefit ratio of routine, primary PcP prophylaxis. I agree with the authors that primary PcP prophylaxis should be considered in patients treated with rituximab,1 but not solely for the duration of B-cell depletion.

References

Martin-Garrido I, Carmona EM, Specks U, Limper AH. Pneumocystispneumonia in patients treated with rituximab. Chest. 2013;144(1):258-265.
 
Green H, Paul M, Vidal L, Leibovici L. Prophylaxis ofPneumocystispneumonia in immunocompromised non-HIV-infected patients: systematic review and meta-analysis of randomized controlled trials. Mayo Clin Proc. 2007;82(9):1052-1059. [CrossRef] [PubMed]
 
Fishman JA. Prevention of infection caused byPneumocystiscarinii in transplant recipients. Clin Infect Dis. 2001;33(8):1397-1405. [CrossRef] [PubMed]
 

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References

Martin-Garrido I, Carmona EM, Specks U, Limper AH. Pneumocystispneumonia in patients treated with rituximab. Chest. 2013;144(1):258-265.
 
Green H, Paul M, Vidal L, Leibovici L. Prophylaxis ofPneumocystispneumonia in immunocompromised non-HIV-infected patients: systematic review and meta-analysis of randomized controlled trials. Mayo Clin Proc. 2007;82(9):1052-1059. [CrossRef] [PubMed]
 
Fishman JA. Prevention of infection caused byPneumocystiscarinii in transplant recipients. Clin Infect Dis. 2001;33(8):1397-1405. [CrossRef] [PubMed]
 
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