359. Pneumocystis jirovecii pneumonia (PJP) among incident cases of giant cell arteritis and polymyalgia rheumatica
Creators: name: Putman1, Michael
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background:</strong> Prophylaxis against pneumocystis jiroveci pneumonia (PJP) has been conditionally recommended for patients with small vessel vasculitis who are receiving moderate doses of glucocorticoids and either rituximab or cyclophosphamide. Patients with giant cell arteritis (GCA) or polymyalgia rheumatica (PMR) also receive moderate-high doses of glucocorticoids after diagnosis and may be at an elevated risk of PJP. The objective of this study was to describe the incidence of PJP among patients on treatment for newly diagnosed GCA or P <strong>Methods:</strong> A retrospective cohort study was conducted using data from the TriNetX (Cambridge, MA, USA) electronic health records database, which includes records from multiple United States health organizations. Patients with GCA were identified using validated case-finding algorith (PPV 79%), which required (1) 2 encounters with GCA diagnostic codes (ICD-9-CM 446.5/ICD-10 M31.6 or M31.5) that occurred at least 30 days apart and (2) at least one moderate-high dose prednisone prescription (greater than or equal to 20mg/day of prednisone or one dose of 500mg or greater intravenous methylprednisolone). Patients with Pwere identified using 2 encounters with a Pdiagnostic code (ICD-9-CM 725/ICD-10 M35.3) at least 30 days apart, any dose of prednisone, and not meeting the criteria for GCA. The index date was defined as the first date of moderate-high dose prednisone for GCA and the first date of any prednisone prescription for P PJP infection was defined by any encounter with a diagnostic code for PJP (ICD-9-CM 136.3/ICD-10 B59) or any positive beta-d-glucan test for PJP within 1 year of the index date. Patients who were under 50 years of age at the index date or had any PJP code within the year prior to the index date were excluded. Comorbidities were identified using validated ICD-9/ICD-10 codes, and comorbidity burden was calculated using the Charlson comorbidity index (CCI). Follow up time was calculated with respect to person-years and limited to 1 year after the index date. <strong>Results:</strong> We identified 1,450 incident cases of GCA (index-year follow-up time of 1,254 patient-years) and 23,935 incident cases of P(index-year follow-up time 21,448 patient-years). The mean age for GCA was 73.6 (SD 8.2) and the mean age for Pwas 71.9 (SD 8.5). The majority of patients were female (68% GCA, 59% PMR) and reported white (79% GCA, 85% PMR) or black (9% GCA, 6% PMR) race/ethnicity. Common comorbidities at baseline included chronic obstructive pulmonary disease (34% GCA, 24% PMR), diabetes without complication (28% GCA, 20% PMR), renal disease (20% GCA, 13% PMR), and congestive heart failure (18% GCA, 11% PMR). The mean weighted CCI was 3.2 (SD 2.8) for GCA and 2.6 (2.2) for P A minority of patients received trimethoprim-sulfamethoxazole or dapsone for presumed prophylaxis (14% GCA, 5% PMR). One case of PJP was identified among patients with GCA for an incident-rate of 0.80 cases per 1,000 patient-years. Eight cases of PJP were identified among patients with Pfor an incident-rate of 0.37 cases per 1,000 patient-years. Two of the patients who contracted PJP died within the index year, both of whom had a diagnosis of PMR, did not receive bactrim prophylaxis, and died within 30 days of PJP diagnosis. <strong>Conclusions:</strong> In this large analysis of an electronic health records database, PJP was a rare complication in patients with newly diagnosed GCA or P These data do not support routine prescribing of PJP prophylaxis for either group of patients, but additional studies with a better-characterized patient population should be conducted. <strong>Disclosures: </strong>Michael Putman is supported by a Rheumatology Research Foundation Scientist Development Grant