We thank Dr Wallace et al for their response to our recently published article ‘Trimethoprim–sulfamethoxazole prophylaxis prevents severe/life-threatening infections following rituximab in antineutrophil cytoplasm antibody-associated vasculitis’, highlighting some methodological limitations of our study.1 2 One of the limitations mentioned by Wallace and colleagues is the inclusion of incident and prevalent cases and since only 15 out of 192 patients were incident cases, generalisability of our findings for this subset of patients may not be possible. We agree that the use of immunosuppression prior to initiation of rituximab likely confers a risk to develop infectious complications after rituximab administration. Cyclophosphamide was used to control disease in 62 patients the year before rituximab was initiated. Among these, 53 patients had no severe infection (median cyclophosphamide exposure 7 g, range 0.66–45 g), while 9 patients receiving cyclophosphamide the index year before had a severe infection following rituximab (median cyclophosphamide exposure 4.8 g, range 0.8–10 g). While this argues against an immediate impact of cyclophosphamide before rituximab on the risk of severe infections (53/143 with no severe infection against 9/49 with infection received …

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回应：Wallace 等人的“利妥昔单抗后严重感染的风险和抗菌素预防的功效”

我们感谢 Wallace 博士等人对我们最近发表的文章“甲氧苄啶-磺胺甲恶唑预防可预防利妥昔单抗治疗抗中性粒细胞胞质抗体相关血管炎后的严重/危及生命的感染”的回应，强调了我们研究的一些方法学局限性。1 2 Wallace 及其同事提到的局限性是包含了事件和流行病例，并且由于 192 名患者中只有 15 名是事件病例，因此我们的研究结果可能无法推广到这部分患者。我们同意在开始利妥昔单抗之前使用免疫抑制可能会增加利妥昔单抗给药后发生感染并发症的风险。在利妥昔单抗开始使用前一年，环磷酰胺用于控制 62 名患者的疾病。在这些当中，53 名患者没有严重感染（中位环磷酰胺暴露 7 g，范围 0.66-45 g），而 9 名在前一年接受环磷酰胺的患者在利妥昔单抗后出现严重感染（中位环磷酰胺暴露 4.8 g，范围 0.8-10 g）。虽然这反对在利妥昔单抗之前使用环磷酰胺对严重感染风险的直接影响（53/143 没有严重感染，9/49 接受感染……