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

• Published in: Arthritis & rheumatology (Hoboken, N.J.) N.J.), 2016-03, Vol.68 (3), p.597-603
• Main Authors: Salt, Elizabeth, Wiggins, Amanda T., Rayens, Mary Kay, Huaman, Moises A., Mannino, David, Schwieterman, Philip, Merkley, Scott A., Jones, Allison R., Crofford, Leslie J.
• Format: Article
• Language: English
• Subjects: Blastomycosis - etiology; Case-Control Studies; Coccidioidomycosis - etiology; Cryptococcosis - etiology; Cryptococcus; Female; Gangrene; Histoplasmosis - etiology; Humans; Infections; Male; Middle Aged; Mycobacterium; Mycobacterium Infections - etiology; Mycoses - etiology; Pneumonia, Pneumocystis - etiology; Prednisone - administration & dosage; Prednisone - adverse effects; Risk Factors; Tuberculosis - etiology; Tumor necrosis factor-TNF; Tumor Necrosis Factors - antagonists & inhibitors
• ISSN: 2326-5191; 2326-5205
• DOI: 10.1002/art.39468

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.