@article{b2e27329f40f4e75b4f05f11b1aae456,
title = "Practice Patterns of Pneumocystis Pneumonia Prophylaxis in Connective Tissue Diseases: A Survey of Infectious Disease Physicians",
abstract = "Background: Immunosuppressive therapy for connective tissue diseases (CTDs) increases risk for opportunistic infections including Pneumocystis pneumonia (PCP). High mortality rates are reported in CTD patients with PCP, which suggests a potential need for prophylaxis, but indications remain poorly defined. Wide variations in the use of PCP prophylaxis among rheumatologists have been documented. This study evaluated PCP prophylaxis patterns for CTD patients among infectious disease (ID) physicians. Methods: An electronic survey was emailed to 1264 adult ID physicians who are members of the Infectious Diseases Society of America Emerging Infections Network. Results: Six hundred thirty-one physicians responded to the survey. Respondents to the survey were more likely to work in academics (P =. 02) and be early (<5 years) or late (≥25 years) in their careers (P =. 0002). Forty-three percent (n = 269) made no recommendations for PCP prophylaxis in non-HIV patients. Of the 362 respondents who did make such recommendations, the greatest consensus for disease-based prophylaxis was for granulomatosis with polyangiitis (53%). For therapy-based prophylaxis, corticosteroids ≥20 mg/d was the most frequently cited indication (87%). Surrogate laboratory markers to aid in decisions about prophylaxis were not routinely used (21%). Although the majority recommended discontinuation of PCP prophylaxis with tapering of corticosteroids (65%), there was variability in the specific dose. Eighty-nine percent of respondents felt that guidelines about PCP prophylaxis would be helpful. Conclusions: There is little consensus about PCP prophylaxis in CTDs among ID physicians. Guidelines for PCP prophylaxis would be helpful when caring for these complex patients.",
keywords = "PCP, Pneumocystis pneumonia, connective tissue diseases, prophylaxis, rheumatologic disorders",
author = "Wolfe, {Rachel M.} and Beekmann, {Susan E.} and Polgreen, {Philip M.} and Winthrop, {Kevin L.} and Peacock, {James E.}",
note = "Funding Information: A recent review by 2 of the authors of this survey (R.M.W., J.E.P.) concluded that, among patients with CTDs, PCP prophylaxis could be recommended with confidence only for patients with GPA undergoing induction therapy [6]. That proposal was supported by updated recommendations from the European League Against Rheumatism, which added PCP prophylaxis to treatment guidelines of any ANCA-associated vasculitis during induction therapy [22]. The review article by Wolfe and Peacock also offered conditional recommendations for prophylaxis for patients with SLE, inflammatory myositis, PAN, and ANCA-associated vasculitis but not for rheumatoid arthritis, giant cell arteritis, scleroderma, or other CTDs. Other review articles also advocate an individual approach to PCP prophylaxis for these complex patients with CTDs [17]. Funding Information: Potential conflicts of interest. J.E.P. owns common stock in Pfizer, Inc. K.L.W. receives research funding from BMS and serves as a consultant for BMS, Pfizer, Abbvie, Lilly, UCB, Gilead, and Galapagos. All other authors report no conflicts. The authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Funding Information: This publication was supported by Cooperative Agreement Number 1 U50 CK000477, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. Funding Information: Financial support. This publication was supported by Cooperative Agreement Number 1 U50 CK000477, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. Publisher Copyright: {\textcopyright} 2019 The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.",
year = "2019",
month = oct,
day = "5",
doi = "10.1093/ofid/ofz315",
language = "English (US)",
volume = "6",
journal = "Open Forum Infectious Diseases",
issn = "2328-8957",
publisher = "Oxford University Press",
number = "9",
}