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. 2016 Mar;68(3):597-603.
doi: 10.1002/art.39468.

Risk Factors for Targeted Fungal and Mycobacterial Infections in Patients Taking Tumor Necrosis Factor Inhibitors

Elizabeth Salt  1 , Amanda T Wiggins  1 , Mary Kay Rayens  1 , Moises A Huaman  1 , David Mannino  1 , Philip Schwieterman  1 , Scott A Merkley  2 , Allison R Jones  1 , Leslie J Crofford  3
Affiliations

Risk Factors for Targeted Fungal and Mycobacterial Infections in Patients Taking Tumor Necrosis Factor Inhibitors

Elizabeth Salt et al. Arthritis Rheumatol. 2016 Mar.

Abstract

Objective: To identify predictors of the receipt of medical care, including the receipt of pre-drug screening, for diagnostically targeted fungal or mycobacterial infections among patients prescribed a tumor necrosis factor inhibitor (TNFi).

Methods: We conducted a case-control study using deidentified patient health claims information from a data set representing a commercially insured US population of 15 million patients annually from January 1, 2007 to December 31, 2009. Descriptive statistics as well as a 2-sample t-test, chi-square test of association, Fisher's exact test, and multivariate logistic regression were used for data analysis.

Results: A total of 30,772 patients received a TNFi during the study period. Of these, 158 patients (0.51%) developed targeted fungal and/or mycobacterial infections (cases). The median number of infections per case was 1.0 (interquartile range 1.0-2.0). Tuberculosis was diagnosed in 61% of cases, followed by histoplasmosis in 60%, nontuberculous mycobacterial infections in 11%, coccidioidomycosis in 10%, unspecified fungal infection in 8%, blastomycosis in 4%, cryptococcal infection in 3%, and pneumocystosis in 2%. Compared to controls (n = 474), a higher proportion of cases were prescribed prednisone (55% versus 37%; P < 0.001). Patients who were prescribed prednisone during the study period were twice as likely as those not taking prednisone to seek medical care attributable to a targeted fungal or mycobacterial infection (odds ratio 2.03; P < 0.001).

Conclusion: Development of a targeted fungal or mycobacterial infection among patients taking a TNFi is rare. Concomitant use of prednisone predicted development of such infections.

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Figures

Figure 1
Figure 1
Flow chart showing derivation of the cases and controls for the study. TNFi = tumor necrosis factor inhibitor.
Figure 2
Figure 2
Percentages of different types of infections in each US Census region. Some of the 158 persons in our sample had >1 infection. Therefore, a total of 253 infections were distributed among the West (n = 54), Northeast (n = 26), Midwest (n = 59), and South (n = 114) regions.
See this image and copyright information in PMC

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