Scholarlink

Background <p>Atovaquone (Atov), a second-line drug, is used to treat patients with <i>Pneumocystis</i> pneumonia (PCP) who cannot tolerate sulfamethoxazole/trimethoprim (SMX/TMP). However, the efficacy and safety of Atov are based on clinical trials conducted in patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome, with limited data available on HIV-uninfected individuals with PCP (non-HIV PCP). In this study, we retrospectively evaluated the clinical outcomes of switching from SMX/TMP to Atov in patients with non-HIV PCP.</p> Methods <p>The study included patients with non-HIV PCP who were admitted to Fukuoka University Hospital between 2016 and 2023 and initially received SMX/TMP therapy. The primary endpoint was 30-day survival rate from the date of PCP diagnosis. Secondary endpoints included factors associated with mortality and the cumulative incidence of switching from SMX/TMP to Atov.</p> Results <p>Of the 56 patients receiving SMX/TMP therapy for PCP, 17 were switched to Atov due to SMX/TMP-related side effects. The Kaplan–Meier estimated 30-day survival was 76.9% in the “remained on” SMX/TMP group and 82.4% in the “switched to” Atov group (log-rank test, <i>P</i> = 0.58). Univariable logistic regression analysis of 30-day mortality showed that switching to Atov was not associated with higher mortality compared with continued SMX/TMP therapy (odds ratio 0.71, 95% confidence interval 0.17 to 3.05). The Kaplan–Meier estimated cumulative incidence of switching from SMX/TMP to Atov during the PCP treatment period was 33.8%.</p> Conclusion <p>Our data suggest that switching from SMX/TMP to Atov may not be associated with worse survival. Long-term administration of SMX/TMP is often challenging due to its side effects, and in this study, more than 30% of patients were unable to tolerate its therapeutic dose. Our findings support the role of Atov as a viable second-line treatment for PCP in immunocompromised patients, such as those with non-HIV PCP.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Clinical outcomes after switching from sulfamethoxazole-trimethoprim to atovaquone due to intolerance in patients with non-HIV Pneumocystis pneumonia: a single-center retrospective study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年1月13日

查看全文
  • Yukino Shirakawa,
  • Takafumi Nakano,
  • Keisuke Sato,
  • Yuka Takahashi,
  • Mika Higashi,
  • Yukiomi Eguchi,
  • Takuya Yamashina,
  • Tadahiro Ikeuchi,
  • Susumu Kaneshige,
  • Masanobu Uchiyama,
  • Atsushi Togawa,
  • Koichi Matsuo,
  • Hidetoshi Kamimura

摘要

Background

Atovaquone (Atov), a second-line drug, is used to treat patients with Pneumocystis pneumonia (PCP) who cannot tolerate sulfamethoxazole/trimethoprim (SMX/TMP). However, the efficacy and safety of Atov are based on clinical trials conducted in patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome, with limited data available on HIV-uninfected individuals with PCP (non-HIV PCP). In this study, we retrospectively evaluated the clinical outcomes of switching from SMX/TMP to Atov in patients with non-HIV PCP.

Methods

The study included patients with non-HIV PCP who were admitted to Fukuoka University Hospital between 2016 and 2023 and initially received SMX/TMP therapy. The primary endpoint was 30-day survival rate from the date of PCP diagnosis. Secondary endpoints included factors associated with mortality and the cumulative incidence of switching from SMX/TMP to Atov.

Results

Of the 56 patients receiving SMX/TMP therapy for PCP, 17 were switched to Atov due to SMX/TMP-related side effects. The Kaplan–Meier estimated 30-day survival was 76.9% in the “remained on” SMX/TMP group and 82.4% in the “switched to” Atov group (log-rank test, P = 0.58). Univariable logistic regression analysis of 30-day mortality showed that switching to Atov was not associated with higher mortality compared with continued SMX/TMP therapy (odds ratio 0.71, 95% confidence interval 0.17 to 3.05). The Kaplan–Meier estimated cumulative incidence of switching from SMX/TMP to Atov during the PCP treatment period was 33.8%.

Conclusion

Our data suggest that switching from SMX/TMP to Atov may not be associated with worse survival. Long-term administration of SMX/TMP is often challenging due to its side effects, and in this study, more than 30% of patients were unable to tolerate its therapeutic dose. Our findings support the role of Atov as a viable second-line treatment for PCP in immunocompromised patients, such as those with non-HIV PCP.