Prophylaxis against pneumocystis jirovecii pneumonia (PJP) in autoimmune rheumatic diseases: a systematic literature review towards the achievement of a consensus

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Introduction: PJP is associated with significant morbidity and mortality in non-HIV immunocompromised patients. We conducted a systematic literature review and meta-analysis (M-A) to evaluate the efficacy and safety of PJP prophylaxis with trimethoprim-sulfamethoxazole(TMP-SMX)in patients with autoimmune rheumatic diseases(AIRDs)receiving immunosuppressive therapy. Methods: We included studies published up to October 2024 assessing the efficacy of PJP prophylaxis,identified through a MEDLINE search.A meta-analysis of odds ratios(ORs)for PJP incidence between prophylaxis and controls was performed using a random-effects model. Metaregressions were conducted including proportion of subjects with ILD and AIIRD type. Results: Among 1,766 identified references,3 randomized controlled trials (RCTs) and 23 non-RCT observational studies were included. The overall M-A demonstrated a significantly lower OR for PJP incidence in patients receiving prophylaxis(Figure 1), with a number needed to treat of 25. Meta-regression analysis showed that neither the proportion of subjects with ILD nor the specific AIRD type significantly influenced efficacy. Egger’s test did not suggest publication bias(p=0.39). Conclusion: TMP-SMX prophylaxis is effective in reducing PJP events in AIIRDs subjects; presence of concurrent ILD or the specific AIIRD type does not seem to influence this benefit. erj;66/suppl_69/PA1743/F1 F1 F1

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