title: Safety and efficacy of upfront graded administration of trimethoprim-sulfamethoxazole in systemic lupus erythematosus: A retrospective cohort study.
abstract: OBJECTIVE
  Trimethoprim-sulfamethoxazole (TMP/SMX) is effective as prophylaxis against many infections in immunocompromised patients. However, it is not commonly prescribed for patients with systemic lupus erythematous (SLE) due to the risk of adverse reactions (ADRs). An upfront graded administration protocol for TMP/SMX was adopted, and its safety and efficacy were assessed.
  
  
  METHODS
  Data from 59 patients with SLE patients who received prophylactic TMP/SMX were retrospectively analyzed. The incidence and risk factors for ADRs in patients who received TMP/SMX before and after the introduction of graded administration were assessed.
  
  
  RESULTS
  The incidence of ADRs was 41.9% in the non-graded administration group, vs. 10.7% in the graded administration group (p = 0.009). The rate of high fever, liver function test (LFT) abnormality, shortness of breath, and hospitalization were reduced in upfront graded administration group. In addition, a higher rate of anti-Ro/SS-A positivity was found in patients experienced ADRs (46.2% in reactors vs. 5.6% in non-reactors; p = 0.012) in the non-graded administration group.
  
  
  CONCLUSIONS
  Upfront graded administration of TMP/SMX reduces the incidence and severity of ADRs in SLE patients. The high incidence of TMP/SMX ADRs in SLE patients was also confirmed, especially when anti-Ro/SS-A antibody is present.
authors.affiliation: a Immuno-Rheumatology Center, St. Luke's International Hospital, St. Luke's International University , Tokyo , Japan .
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Suyama
authors.affiliation: a Immuno-Rheumatology Center, St. Luke's International Hospital, St. Luke's International University , Tokyo , Japan .
authors.forename: Masato
authors.initials: M
authors.lastname: Okada
authors.affiliation: a Immuno-Rheumatology Center, St. Luke's International Hospital, St. Luke's International University , Tokyo , Japan .
authors.forename: Ryo
authors.initials: R
authors.lastname: Rokutanda
authors.affiliation: a Immuno-Rheumatology Center, St. Luke's International Hospital, St. Luke's International University , Tokyo , Japan .
authors.forename: Chisun
authors.initials: C
authors.lastname: Min
authors.affiliation: a Immuno-Rheumatology Center, St. Luke's International Hospital, St. Luke's International University , Tokyo , Japan .
authors.forename: Belinda
authors.initials: B
authors.lastname: Sassé
authors.affiliation: b Center for Clinical Epidemiology, St Luke's Life Science Institute , Tokyo , Japan .
authors.forename: Daiki
authors.initials: D
authors.lastname: Kobayashi
authors.affiliation: b Center for Clinical Epidemiology, St Luke's Life Science Institute , Tokyo , Japan .
authors.forename: Osamu
authors.initials: O
authors.lastname: Takahashi
authors.affiliation: b Center for Clinical Epidemiology, St Luke's Life Science Institute , Tokyo , Japan .
authors.forename: Gautam A
authors.initials: GA
authors.lastname: Deshpande
authors.affiliation: c Department of Rheumatology , Kameda Medical Center , Kamogawa City, Chiba , Japan , and.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Matsui
authors.affiliation: d Institute of Rheumatology, Tokyo Women's Medical University , Shinjuku-Ku, Tokyo , Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kawaguchi
authors.affiliation: a Immuno-Rheumatology Center, St. Luke's International Hospital, St. Luke's International University , Tokyo , Japan .
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Kishimoto
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Adverse drug reactions; Anti-Ro/SS-A antibody graded administration; Systemic lupus erythematosus; Trimethoprim–sulfamethoxazole