Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Rheumatologists Practice for Prescribing Pneumocystis Prophylaxis

Cettomai,  Deanna, Gelber,  Allan C., Christopher-Stine,  Lisa

Purpose:

Consensus guidelines for Pneumocystis pneumonia (PCP) prophylaxis in HIV-negative patients with rheumatologic disorders are lacking. We assessed rheumatologists' practice patterns for prescribing PCP prophylaxis.

Method:

Invitations to participate in an online international survey were emailed to 3150 American College of Rheumatology members.

Results:

Surveys were retuned by 727 (23.14%) individuals, of whom 505 (69.5%) reported prescribing prophylaxis. In univariate analyses, factors associated with significantly higher odds of prescribing PCP prophylaxis included female gender, US-based and academic practice of <10 years duration, having previously treated a patient with PCP pneumonia, and a practice with a higher proportion of patients on chronic glucocorticoids or other immunosuppressant medications. In multivariate analysis, rheumatologists early in their careers and those with a US-based practice, or a higher proportion of patients treated with chronic glucocorticoid therapy were most likely to prescribe PCP prophylaxis. Among the prescribers, the most important determinant factors for prescribing prophylaxis were treatment regimen (68.6%), rheumatologic diagnosis (9.3%), and medication dosage (8.3%).

 Prescribe PCP ProphylaxisUnivariate Logistic Regression Multivariate Logistic Regression 
Demographic Characteristicn (%)OR (95% CI)pOR (95% CI)p
Female gender191 (74.9)1.47 (1.04, 2.08)0.031.01 (0.68, 1.50)0.97
Male gender308 (67.0)    
US-based practice420 (72.0)1.77 (1.20, 2.61)0.0041.974 (1.27, 3.05)0.003
Internationally-based practice80 (59.2)    
Academic practice248 (81.0)2.75 (1.94, 3.89)< 0.0011.81 (1.23, 2.66)0.003
Non-academic practice252 (60.9)    
<=10 years in practice206 (86.6)4.08 (2.69, 6.18)< 0.0014.13 (2.62, 6.51)<0.001
>10 years in practice292 (61.2)    
>=10% patients on chronic glucocorticoids414 (72.8)2.04 (1.40, 2.96)< 0.0012.11 (1.38, 3.23)0.001
<10% patients on chronic glucocorticoids84 (56.8)    
>=10% patients on other immunosuppressants488 (70.5)3.19 (1.48, 6.86)0.0032.26 (0.98, 5.26)0.06
<10% patients on other immunosuppressants12 (42.8)    
Caring for a patient who developed PCP159 (82.8)2.62 (1.73, 3.98)< 0.0013.04 (1.92, 4.82)<0.001
Never caring for a patient who developed PCP345 (64.7)    
<=10 patients with rheumatologic diagnosis under clinical care each week43 (76.8)1.48 (0.78, 2.82)0.23—*—*
>10 patients with rheumatologic diagnosis under care each week455 (69.0)    
Proportion of respondents with characteristic prescribing PCP prophylaxis.
*Not included in multivariate analysis because variable did not reach statistical significance in the univariate analysis.

Conclusion:

Nearly one-third (30%) of rheumatologists surveyed reported that they never prescribed PCP prophylaxis. While the patients for whom physicians would prescribe prophylaxis varied widely, physician demographic characteristics were strongly predictive of prophylaxis use. Consensus guidelines would be helpful to guide clinical decision-making regarding PCP prophylaxis in HIV-negative patients with rheumatologic diagnoses.

To cite this abstract, please use the following information:
Cettomai, Deanna, Gelber, Allan C., Christopher-Stine, Lisa; Rheumatologists Practice for Prescribing Pneumocystis Prophylaxis [abstract]. Arthritis Rheum 2009;60 Suppl 10 :327
DOI: 10.1002/art.25410

Abstract Supplement

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