Secondary prevention
Patients should be immunised as per immunocompromised host- and age-appropriate protocols.
Prophylaxis against Pneumocystis jirovecii is indicated when patients are taking prednisolone ≥20 mg/day, or cyclophosphamide or rituximab.[34][54] Prophylaxis is typically continued while on other immunosuppressants, although evidence to support this is not as strong. See Pneumocystis jirovecii pneumonia.
Prophylaxis against bone loss for patients treated with corticosteroids should be considered based on individual factors.[55] Screening and preventive measures against corticosteroid-induced osteoporosis should be instituted, along with monitoring and treatment for other complications of corticosteroid treatment (e.g., hypertension, diabetes mellitus, dyslipidaemia).[55] See Osteoporosis (Management approach).
Patients given cyclophosphamide: mesna (mercaptoethane sulfonate) binds to and deactivates acrolein, the urotoxic metabolite of cyclophosphamide in the urinary bladder. Mesna may be given with intravenous cyclophosphamide, in addition to copious fluids, to prevent urotoxicity. Bladder cancer is a known complication of cyclophosphamide treatment. Risk depends on the cumulative dose of the drug. Haematuria in a patient who has been exposed to cyclophosphamide mandates cystoscopy. Screening cystoscopy is recommended every 3 years in patients who have received cyclophosphamide for more than 1 year in total.[40]
Use of this content is subject to our disclaimer