Skip to main content

PJP Prophylaxis Needed with Steroids and Rituximab

Pneumocystis jirovecii pneumonia (PJP) can be a life-threatening infection in immunocompromised patients. The 2023 EULAR Vasculitis guidelines recommends primary prophylaxis with antibiotics, especially in rheumatic disease patients receiving rituximab (RTX).

This analysis identified RTX treated patients from 3 medical centers in South Korea between 2004-2020, and analyzed 818 RTX treated rheumatic patients, 419 of whom received trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis.

Over 663 patient-years, they identified 11 PJP cases, with a 64% mortality rate.

The PJP risk was most influenced by concomitant high-dose glucocorticoid use (≥30mg/day of prednisone during 4 weeks after rituximab administration).

The incidence of PJP (per 100 person-years) was:

  • 7.93 (2.91-17.25) on high-dose glucocorticoids
  • 0.40 (0.01-2.25) NOT on steroids

For those on RTX alone, prophylactic TMP-SMX significantly reduced the overall PJP incidence (HR 0.11 [0.03-0.37]), the NNT to prevent one PJP was higher than the NNH (146 vs. 86). But with concomitant high-dose glucocorticoids, the protective effect of TMP-SMX was greater with the NNT falling to 20 (10.7-65.7) on TMP-SMX.

The benefit of primary PJP prophylaxis appears to be greatest in rheumatic patients receiving RTX and concomitant high-dose glucocorticoid treatment. 


If you are a health practitioner, you may to comment.

Due to the nature of these comment forums, only health practitioners are allowed to comment at this time.

The author has no conflicts of interest to disclose related to this subject