Efficacy of Pneumocystis jirovecii Pneumonia Prophylaxis in Preventing Infections among Patients with Kidney Disease Receiving Rituximab Therapy

Background: Pneumocystis jirovecii pneumonia (PJP) prophylaxis is frequently used in kidney disease patients during rituximab (RTX) therapy. However, the effectiveness of PJP prophylaxis in this context is uncertain. Methods: This retrospective study included adult patients with AAV, LN, MN, primary podocytopathy who began RTX therapy between 2012 and 2022. The association between treatment group (with vs. without PJP prophylaxis at RTX initiation) and the risk of incident infection post-treatment was analyzed using Cox proportional regression model. Patients were censored at death, transplantation, loss to follow-up, or one year post-treatment initiation, whichever came first. Results: A total of 441 patients met inclusion criteria. At the time of first dose of RTX , 316 (72%) were on PJP prophylaxis, and 125 (28%) were on RTX alone (Fig.). AAV patients were more likely to receive PJP prophylaxis with RTX, whereas MN patients were more likely to receive RTX alone (P<0.001). Overall, no significant difference in infection risk was found between the groups (HR [95% CI], 0.92 [0.57, 1.47], P=0.71). Adjusting for kidney disease type, PJP prophylaxis was linked to a lower infection risk, though not statistically significant (HR, 0.67 [0.39, 1.15], P=0.15). Stratified by kidney disease type, PJP prophylaxis was associated with a lower infection risk in both AAV patients (HR 0.74 [0.34, 1.65], P=0.46) and non-AAV patients (HR 0.61 [0.28, 1.33], P=0.21), but not statistically significant. Conclusion: The study found no significant protective effect of PJP prophylaxis on incident infections in kidney disease patients receiving RTX treatment. However, a reduced risk was noted when adjusting for disease types and in AAV patients. Further research is needed to evaluate these findings.