Yael A Leshem1,2, Igor Snast1, Rivka Friedland3, Lihi Atzmony1, Assi Levi1,2, Emmilia Hodak1,2, Daniel Mimouni4,5. 1. Department of Dermatology, Beilinson Hospital, Derech Ze'ev Jabotinsky 39, Petach Tikva, 4941492, Israel. 2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Schneider Children's Medical Center, Petach Tikva, Israel. 4. Department of Dermatology, Beilinson Hospital, Derech Ze'ev Jabotinsky 39, Petach Tikva, 4941492, Israel. daniel.mimouni@gmail.com. 5. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. daniel.mimouni@gmail.com.
Abstract
BACKGROUND: Opportunistic infections (OIs) are a dreaded adverse effect of immunosuppressive therapy, leading to the use of opportunistic infection prophylaxis (OIP) in many immunosuppressed conditions. However, guidelines for OIP in pemphigus are lacking. OBJECTIVE: Our objective was to evaluate the approach of leading pemphigus experts towards OIP. METHODS: We conducted an online survey of OIP trends. RESULTS: The survey was completed by 33 experts. Prior to initiation of immunosuppressive therapy, 75% routinely screened for hepatitis viruses, and at least half screened for HIV or tuberculosis. Most experts (76%) prescribed OIP but to <10% of their patients, and the most frequent drugs of choice were sulfamethoxazole/trimethoprim and acyclovir. Most experts agreed that treatment with three or more immunosuppressive agents or a previous history of OIs would lead to the use of OIP that was then discontinued with cessation of immunosuppression. The arguments against OIP were the lack of evidence for its necessity and concern about side effects or emergence of resistant pathogens. The surveyed experts treated patients with severe disease in a tertiary care setting, which may have led to an overestimation of the use of OIP. Infectious disease specialists were not included. CONCLUSION: Substantial disparities exist in approaches to OIP for patients with pemphigus, including the decision to treat, type of treatment, and risk stratification among pemphigus experts.
BACKGROUND:Opportunistic infections (OIs) are a dreaded adverse effect of immunosuppressive therapy, leading to the use of opportunistic infection prophylaxis (OIP) in many immunosuppressed conditions. However, guidelines for OIP in pemphigus are lacking. OBJECTIVE: Our objective was to evaluate the approach of leading pemphigus experts towards OIP. METHODS: We conducted an online survey of OIP trends. RESULTS: The survey was completed by 33 experts. Prior to initiation of immunosuppressive therapy, 75% routinely screened for hepatitis viruses, and at least half screened for HIV or tuberculosis. Most experts (76%) prescribed OIP but to <10% of their patients, and the most frequent drugs of choice were sulfamethoxazole/trimethoprim and acyclovir. Most experts agreed that treatment with three or more immunosuppressive agents or a previous history of OIs would lead to the use of OIP that was then discontinued with cessation of immunosuppression. The arguments against OIP were the lack of evidence for its necessity and concern about side effects or emergence of resistant pathogens. The surveyed experts treated patients with severe disease in a tertiary care setting, which may have led to an overestimation of the use of OIP. Infectious disease specialists were not included. CONCLUSION: Substantial disparities exist in approaches to OIP for patients with pemphigus, including the decision to treat, type of treatment, and risk stratification among pemphigus experts.
Authors: Kyle T Amber; Aniek Lamberts; Farzan Solimani; Arianna F Agnoletti; Dario Didona; Ilona Euverman; Emanuele Cozzani; Lee Haur Yueh; Giovanni Di Zenzo; Yael Anne Leshem; Daniel Mimouni; Michael Hertl; Barbara Horvath Journal: JAMA Dermatol Date: 2017-11-01 Impact factor: 10.282