47 pneumocystis jirovecii pneumonia prophylaxis in patients with glioma receiving concurrent chemoradiation: a systematic review
Abstract
Abstract BACKGROUND Routine antibiotic prophylaxis against pneumocystis jirovecii pneumonia (PJP) is mandated during concurrent temozolomide and radiation therapy (TMZ-RT) based on early studies in patients with glioma. However, the true risk of PJP in this population may have been overestimated and calls into question the value of routine prophylaxis in this population considering the possible harms. METHODS A systematic search was conducted in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from inception up until Jan 2024. Eligible articles were randomized controlled trials, prospective and retrospective cohort studies, and chart reviews of glioma patients treated with TMZ-RT, with or without PJP prophylaxis, with PJP incidence as a reported outcome. Study outcomes included overall PJP incidence, and PJP incidence based on prophylaxis use, corticosteroid exposure, and lymphopenia. FINDINGS A total of 28 out of 3,003 initially identified studies were included in this review. Of the combined 11,810 glioma patients, 11,077 received TMZ-RT. The incidence of PJP cases amongst all TMZ-RT patients was 0·7% (71/10,118). Seven out of 28 studies recorded PJP prophylaxis use, including five prospective and two retrospective designs. From these studies, we determined PJP incidence amongst subgroups with and without prophylaxis to be 0·8% (14/1,765) and 0·3% (9/2,719), respectively. Corticosteroid exposure was recorded in a median of 56·5% (range: 27·3% to 89·0%)…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 11,810 participants or records.
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