Pneumocystis jiroveci Prophylaxis with Rituximab

Introduction: Pneumocystis jiroveci pneumonia (PJP) prophylaxis is highly effective in HIV patients. The objective of this study was to examine the efficacy and adverse effects of PJP prophylaxis among rituximab treated non–HIV patients. Methods: We performed a systematic review based on the Preferred Reporting Items for Systematic Review and Meta‑Analyses (PRISMA) model. Results: Eight retrospective studies were included with a combined cohort of 6048 patients. The most common prophylaxis drug used was trimethoprim/sulfamethoxazole (TMP‑SMX). There were 17 PJP infections in the prophylaxis arm against 147 in the control arm (incidence 0.3% vs 2.4%; OR, 0.35; 95% CI, 0.19‑0.64). The number needed to treat (NNT) to prevent 1 PJP episode was 36 patients (CER, 3.6%). The mortality rate due to PJP was 25%. All ADRs (adverse drug reactions) resolved with TMP‑SMX discontinuation. Conclusion: Prophylaxis with TMP‑SMX seems justifiable in combined therapies with rituximab. But in monotherapy, the results are not robust. The decision should be patient‑based. The optimal duration of prophylaxis is also unclear.