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Risk of severe infection following rituximab and the efficacy of antimicrobial prophylaxis
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  1. Zachary Scott Wallace1,2,3,
  2. Hyon Choi1,2,3,
  3. John H Stone1,3
  1. 1 Rheumatology Unit, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, USA
  2. 2 Clinical Epidemiology Unit, Division of Rheumatology, Allergy and Immunology, Harvard Medical School, Boston, USA
  3. 3 Massachusetts General Hospital and Harvard Medical School, Boston, USA
  1. Correspondence to Dr Zachary Scott Wallace, Rheumatology Unit, Clinical Epidemiology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; zswallace{at}mgh.harvard.edu

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We read with interest the article ‘Trimethoprim–sulfamethoxazole prophylaxis prevents severe/life-threatening infections following rituximab in antineutrophil cytoplasm antibody-associated vasculitis’ by Kronbichler et al.1 Severe infections continue to be a significant cause of morbidity and mortality in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), and we commend the authors for pursuing this study. However, we have several concerns regarding their methodologies.

First, more than 90% of patients with AAV analysed were prevalent cases. This may limit the generalisability of their findings to incident cases in whom there has been no prior treatment with cyclophosphamide or other immunosuppressive agents. As the authors note, there was an average delay of 4 years …

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