Bactrim Efficacy in Preventing Infections in Glomerular Diseases Receiving Rituximab.

Area of Science:

• Nephrology and Immunology
• Pharmacology and Therapeutics

Background:

• Rituximab is used to treat various glomerular diseases, but increases infection risk.
• Prophylaxis with sulfamethoxazole and trimethoprim (Bactrim) is common but its efficacy in kidney disease patients on rituximab is not well-established.

Purpose of the Study:

• To evaluate the effectiveness of Bactrim prophylaxis in preventing severe infections in patients with kidney disease undergoing rituximab therapy.
• To compare infection rates between patients receiving Bactrim and those not receiving it, stratified by glomerular disease type.

Main Methods:

• Retrospective cohort study of adult patients with antineutrophil cytoplasmic antibody-associated vasculitis renal involvement (AAV-R) or renal-limited diseases (membranous nephropathy, minimal change disease, focal segmental glomerulosclerosis) treated with rituximab between 2012-2022.
• Analysis of severe infection incidence within 1 year of rituximab initiation.
• Kaplan-Meier and Cox proportional hazards models were used to assess the association between Bactrim use and infection risk.

Main Results:

• A total of 419 patients were included; 248 with AAV-R and 171 with other glomerular diseases.
• Bactrim use was associated with a reduced infection incidence at 1 year in AAV-R patients (21% vs. 32%) and in other glomerular disease patients (11% vs. 17%).
• Multivariable analysis confirmed Bactrim significantly reduced infection risk in AAV-R (HR 0.53, P=0.03) but not in other glomerular diseases (HR 0.68, P=0.33).

Conclusions:

• Bactrim prophylaxis may be particularly beneficial in reducing infection risk for patients with AAV-R undergoing rituximab therapy.
• The protective effect of Bactrim against severe infections was not statistically significant in patients with membranous nephropathy, minimal change disease, or focal segmental glomerulosclerosis treated with rituximab.