Do patients on biologic drugs for rheumatic disease need PCP prophylaxis?

Joy-Ann Tabanor; Santhanam Lakshminarayanan

doi:10.3949/ccjm.86a.18084

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TABLE 1

Biologic agents used for rheumatic disease

Anti-tumor necrosis factor alpha agents
Adalimumab
Certolizumab
Etanercept
Golimumab
Infliximab

Interleukin 1 receptor antagonists
Anakinra
Canakinumab
Rilonacept

Anti-interleukin 5 antibody
Mepolizumab

Interleukin 6 receptor antagonists
Sarilumab
Tocilizumab

Interleukin 12/23 antagonist
Ustekinumab

Interleukin 17 antagonists
Ixekizumab
Secukinumab

T-cell costimulation blocker
Abatacept

Anti-CD20 antibody
Rituximab

Anti-B-cell activating factor (B-lymphocyte stimulator) antibody
Belimumab

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TABLE 2

Risk factors for Pneumocystis jirovecii pneumonia in patients on biologic therapy for rheumatic disease

Clinical risk factors
Age > 65^5,21,22
Preexisting pulmonary disease^9,21,22
Granulomatosis with polyangiitis^4,19
Microscopic polyangiitis⁴
Polyarteritis nodosa¹⁹
Inflammatory myopathy¹⁹
Systemic lupus erythematosus¹⁹

Laboratory testing indicators
Lymphopenia (< 500 cells/mm³)^5,18
Low CD4 count (< 200 cells/mm³)^5,18
Low immunoglobulin G level⁹

Pharmacologic risk factors
Concomitant chronic glucocorticoid therapy^{3–6,9,17,21,28} (≥ 15 mg/day of prednisone for 4 weeks or longer)^4,5
Concomitant therapy with nonbiologic disease-modifying antirheumatic drug or cytotoxic agent^5,7,9,22