Bactrim Efficacy in Preventing Infections in Glomerular Diseases Receiving Rituximab

AbstractRational & Objective The efficacy of Bactrim prophylaxis for infection prevention in kidney disease with rituximab therapy remains unclear. This study investigated its effectiveness in two distinct glomerular disease groups treated with rituximab. Study Design Retrospective cohort study. Setting & Participants Adults with ANCA-associated vasculitis renal involvement (AAV-R) or renal-limited diseases including membranous nephropathy (MN), minimal change disease (MCD) or primary focal segmental glomerulosclerosis (FSGS) who underwent rituximab therapy between 2012 and 2022 at Mayo Clinic. Exposures Receiving Bactrim or not. Outcomes Severe infection during 1-year follow-up after rituximab initiation. Analytical Approach Kaplan-Meier method used for the probability of survival free of infection. Cox proportional hazards models used for the association between Bactrim use and risk of infection. Results Among 419 patients, 248 were diagnosed with AAV-R and 171 with MN/MCD/FSGS. During the initial rituximab therapy session, 186 AAV-R (75%) and 76 MN/MCD/FSGS (44%) were concurrently administered Bactrim. Among AAV-R, patients prescribed Bactrim versus without Bactrim were generally younger, with lower serum creatinine, elevated white blood cells and neutrophils, and higher steroid use (P P P = 0.03). In contrast, no significant association was found in the MN/MCD/FSGS group (HR 0.68, 95% CI 0.31–1.47, P = 0.33). Limitations Retrospective study. Conclusions Bactrim prophylaxis could be especially beneficial for reducing infection risk in patients with AAV-R undergoing rituximab therapy.