Adverse drug reactions to trimethoprim-sulfamethoxazole in systemic lupus erythematosus

• Published in: Lupus Vol. 30; no. 10; pp. 1679 - 1683
• Main Authors: Izuka, Shinji, Yamashita, Hiroyuki, Takahashi, Yuko, Kaneko, Hiroshi
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.09.2021; Sage Publications Ltd
• Subjects: Antibiotics; Connective Tissue Diseases; Drug-Related Side Effects and Adverse Reactions; Humans; Lupus; Lupus Erythematosus, Systemic; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Multivariate analysis; Pneumonia, Pneumocystis; Retrospective Studies; Risk factors; Sulfamethoxazole; Systemic lupus erythematosus; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Trimethoprim, Sulfamethoxazole Drug Combination - adverse effects; Trimethoprim-sulfamethoxazole; Trimethoprim-sulfamethoxazole; systemic lupus erythematosus; drug-related side effects and adverse reactions; connective tissue diseases
• ISSN: 0961-2033; 1477-0962; 1477-0962
• DOI: 10.1177/09612033211033985

Objectives Trimethoprim-sulfamethoxazole (TMP-SMX), a prophylactic agent against pneumocystis pneumonia (PCP), can cause adverse drug reactions (ADRs), particularly in patients with systemic lupus erythematosus (SLE). However, the risk factors for ADRs remain unclear. Thus, we sought to examine the prevalence of TMP-SMX-related ADRs in patients with SLE and identify specific risk factors for ADR development in these patients. Methods We retrospectively reviewed data from patients with connective tissue disease (CTD) who were administered TMP-SMX as a PCP prophylactic. The prevalence of ADRs was compared between patients with SLE and those with other CTDs. Univariate and multivariate analyses were conducted to identify risk factors for ADRs in patients with SLE. Results Of the 424 patients with CTD included in our study (SLE, n = 162; other CTDs, n = 262), 22 with SLE (13.6%) developed ADRs, and this rate was significantly higher than that observed in patients with non-SLE CTDs (n = 18 [6.9%], p = 0.033). In patients with SLE, univariate analyses revealed direct associations of ADRs with anti-Sm (p < 0.001), anti-RNP (p = 0.02), and anti-Ro/SS-A antibodies (p = 0.042). Multivariate analysis identified a significant association between anti-Sm antibody levels and the development of ADRs (adjusted odds ratio 5.27, 95% confidence interval 1.80–15.40, p = 0.002). Conclusions Patients with SLE who are prophylactically administered TMP-SMX are at high risk of ADRs. Among these patients, those who display a positive anti-Sm antibody should be carefully monitored for ADRs.