title: Pneumocystis               jirovecii pneumonia associated with etanercept treatment in patients with rheumatoid arthritis: a retrospective review of 15 cases and analysis of risk factors.
abstract: OBJECTIVE
  The association of anti-tumor necrosis factor therapy with opportunistic infections in rheumatoid arthritis (RA) patients has been reported. The goal of this study was to clarify the clinical characteristics and the risk factors of RA patients who developed Pneumocystis                   jirovecii pneumonia (PCP) during etanercept therapy.
  
  
  METHODS
  We conducted a multicenter, case-control study in which 15 RA patients who developed PCP were compared with 74 RA patients who did not develop PCP during etanercept therapy.
  
  
  RESULTS
  PCP developed within 26 weeks following the first injection of etanercept in 86.7% of the patients. All PCP patients presented with a rapid and severe clinical course and the overall mortality was 6.7%. Independent risk factors were identified using multivariate analysis and included age ≥65 years [hazard ratio (HR) 3.35, p = 0.037], coexisting lung disease (HR 4.48, p = 0.009), and concomitant methotrexate treatment (HR 4.68, p = 0.005). In patients having a larger number of risk factors, the cumulative probability of developing PCP was significantly higher (p < 0.001 for patients with two or more risk factors vs. those with no risk factor, and p = 0.001 for patients with one risk factor vs. those with no risk factor).
  
  
  CONCLUSIONS
  Physicians must consider the possibility of PCP developing during etanercept therapy in RA patients, particularly if one or more risk factors are present.
authors.affiliation: Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Michi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Ryoko
authors.initials: R
authors.lastname: Sakai
authors.forename: Ryuji
authors.initials: R
authors.lastname: Koike
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Komano
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nanki
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Sakai
authors.forename: Haruhito
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Matsushima
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Kojima
authors.forename: Shuji
authors.initials: S
authors.lastname: Ohta
authors.forename: Yoji
authors.initials: Y
authors.lastname: Ishibe
authors.forename: Takuya
authors.initials: T
authors.lastname: Sawabe
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ota
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Ohishi
authors.forename: Hajime
authors.initials: H
authors.lastname: Miyazato
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Nonomura
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Hayato
authors.initials: H
authors.lastname: Nagasawa
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Ayako
authors.initials: A
authors.lastname: Nakajima
authors.forename: Hideo
authors.initials: H
authors.lastname: Ohtsubo
authors.forename: Makoto
authors.initials: M
authors.lastname: Onishi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Goto
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Dobashi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Miyasaka
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Harigai
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D016022:Case-Control Studies; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000139:chemically induced* / Q000188:drug therapy; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000382:microbiology*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept