Background Salazosulfapyridine is non-antimicrobial sulfonamides, which is used as a synthetic disease modified anti-rheumatic-drug (DMARD) for rheumatoid arthritis and psoriatic arthritis. Prior study suggested sulfa allergy may be more commonly seen in patients with positive anti- Ro/SS-A antibody (anti-Ro).
Objectives To identify the risk factor for adverse effects (AEs) caused by salazosulfapyridine in patients with rheumatic diseases.
Methods We retrospectively identified patients ≥18 years old who received salazosulfapyridine at a tertiary medical center in Japan between 2010–2015. Data were collected on the incidence of AEs, clinical features and autoantibodies.
Results We identified 313 patients with rheumatic diseases who received salazosulfapyridine. Median age was 61 (range, 20–95); 215 of 313 (67%) were female (Table). The incidence of AEs was 15% (48/313); Median duration until developing AEs was 14 days (range, 2–50). AEs included rash (28), fever (19), elevated liver function tests (13), gastrointestinal symptoms (9), lymphadenitis (3), neutropenia and eosinophilia (1). Factors associated with AEs are female gender, positive anti-Ro or psoriatic arthritis. Multivariate logistic controlling for age, gender and anti-Ro showed that positive anti-Ro has 2.33 odds (P=0.03; 95% CI: 1.07–5.08) of having AE of salazosulfapyridine. Among patients without anti-Ro, subjects with psoriasis showed 9.95 odds (P<0.001; 95% CI: 3.51–28.2) of developing AEs than non-psoriatic patients.
Conclusions AEs caused by salazosulfapyridine are common in patients with rheumatic diseases. Presence of anti- Ro or psoriasis may be a risk factor for AEs caused by salazosulfapyridine.
Suyama Y, Okada M, Rokutanda R, et al: Safety and efficacy of upfront graded administration of trimethoprim-sulfamethoxazole in systemic lupus erythematosus: A retrospective cohort study. Mod Rheumatol. 2016;26:557–61.
Maezawa R, Kurasawa K, Arai S, et al: Positivity for anti-RNP antibody is a risk factor for adverse effectscaused by trimethoprim-sulfamethoxazole, a prophylactic agent for P. jiroveci pneumonia, in patients with connective tissue diseases. Mod Rheumatol. 2013;23:62–70.
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.