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Does Trimethoprim-Sulfamethoxazole prophylaxis induce myelosuppression in primary immune deficiency disease patients;

Reem Elajez1, Sabha Nisar1, Mehdi Adeli1,2,3

  • 1Hamad Medical Corporation.

Asian Pacific Journal of Allergy and Immunology
|October 17, 2020
PubMed
Abstract

Insights

Primary immune deficiency (PID) patients on Trimethoprim-Sulfamethoxazole (TMP-SMX) prophylaxis face a higher risk of myelosuppression, particularly affecting neutrophil counts. This increased risk suggests a potential interaction between TMP-SMX and PID, warranting further investigation.

Area of Science:

  • Immunology
  • Pharmacology
  • Hematology

Background:

  • The myelosuppressive effects of Trimethoprim-Sulfamethoxazole (TMP-SMX) in patients with primary immune deficiency (PID) remain unclear.
  • Establishing this risk is crucial for optimizing treatment protocols in PID patients.

Purpose of the Study:

  • To determine if patients with primary immune deficiency (PID) exhibit an elevated risk of myelosuppression when treated with TMP-SMX.
  • To compare myelosuppression rates between PID patients on TMP-SMX, PID patients not on TMP-SMX, and urinary tract infection (UTI) patients receiving TMP-SMX.

Main Methods:

  • A retrospective study involving 122 patients across three groups: PID patients on TMP-SMX prophylaxis, PID patients not on TMP-SMX, and UTI patients on TMP-SMX prophylaxis.
  • Collected complete blood count (CBC) data including WBC, ANC, RBC, and platelet counts at baseline, first, and maximum myelosuppression during TMP-SMX treatment.

Main Results:

  • Significant differences in clinical myelosuppression were observed across groups for ANC (39.0% vs. 8.9% vs. 16.7%), RBC (36.6% vs. 13.3% vs. 13.9%), WBC (41.5% vs. 13.3% vs. 13.9%), and platelets (24.4% vs. 15.6% vs. 2.8%).
  • The higher incidence of myelosuppression in PID patients on TMP-SMX suggests a combined effect of the drug and the underlying immune deficiency.

Conclusions:

  • Primary immune deficiency (PID) patients are at a significantly higher risk of developing myelosuppression, especially neutropenia, secondary to TMP-SMX prophylaxis.
  • This heightened risk in PID patients necessitates careful consideration of TMP-SMX use and warrants further prospective research to confirm the association.

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