From the Guidelines
Benlysta (belimumab) is associated with an increased risk of Pneumocystis jirovecii pneumonia (PJP), a serious opportunistic infection, and patients receiving Benlysta should be considered for PJP prophylaxis, especially those also on other immunosuppressants like corticosteroids or who have severe lupus. The recommended prophylactic regimen is trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of one double-strength tablet (800mg/160mg) three times weekly or one single-strength tablet (400mg/80mg) daily, as supported by the most recent guidelines 1. For patients with sulfa allergies, alternatives include dapsone 100mg daily, atovaquone 1500mg daily, or inhaled pentamidine 300mg monthly. Some key points to consider when deciding on PJP prophylaxis include:
- The patient's overall immunosuppression level, including the use of corticosteroids and other immunosuppressants
- The duration of Benlysta treatment and the need for continued prophylaxis after treatment is stopped
- The patient's risk factors for PJP, including age, underlying disease, and prior infections
- The potential for drug interactions and side effects with PJP prophylaxis medications Prophylaxis should be continued throughout Benlysta treatment and for several months afterward, depending on the patient's overall immunosuppression level, as recommended by recent guidelines 1. Patients should be monitored for symptoms of PJP including progressive dyspnea, fever, and dry cough, especially during the first year of treatment when risk is highest, as suggested by expert consensus 1.
From the Research
Association between Benlysta (Belimumab) and Pneumocystis jirovecii pneumonia (PJP) infection
- There are no direct research papers to assist in answering this question, as none of the provided studies specifically investigate the association between Benlysta (Belimumab) and Pneumocystis jirovecii pneumonia (PJP) infection.
- However, the studies provide information on PJP prophylaxis patterns, risk factors, and treatment options for patients with rheumatic diseases or immunosuppressed individuals 2, 3, 4, 5.
- One study mentions that PJP prophylaxis for patients with rheumatic conditions is inconsistent, with one quarter of patients who have high-risk conditions or high-risk immunosuppressants not receiving prophylaxis 2.
- Another study discusses the use of trimethoprim-sulfamethoxazole for treating PJP in a patient with glucose-6-phosphate dehydrogenase deficiency, highlighting the importance of considering underlying conditions when selecting treatment options 6.
- The studies also emphasize the importance of early diagnosis and correct treatment of PJP, particularly in patients with hematological malignancies or those receiving immunosuppressive medications 3, 4, 5.