Fanny Lanternier1, Florence Tubach2, Philppe Ravaud3, Dominique Salmon4, Pierre Dellamonica5, Stephane Bretagne6, Marie Couret7, Beatrice Bouvard8, Michel Debandt9, Isabelle Gueit10, Jean-Pierre Gendre11, Jean Leone12, Nathalie Nicolas13, Dider Che14, Xavier Mariette15, Olivier Lortholary16. 1. Université Paris Descartes, Sorbonne Paris Cité, IHU Imagine, APHP, Hôpital Necker Enfants malades, Centre d'Infectiologie Necker Pasteur, Service de maladies infectieuses et tropicales, Paris. 2. Université Paris Diderot, Sorbonne Paris Cité, UFR de médecine, Paris; APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, Paris; INSERM, CIE 801, Paris. 3. UMR-S 738, INSERM, Paris; UMR-S 738, Université Paris Diderot, Paris; Université Paris Descartes, Paris; Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, APHP, Paris. 4. Université Paris Descartes, Service de médecine interne, APHP, Hopital Cochin, Paris. 5. Service de maladies infectieuses et tropicales, CHU de Nice, Nice. 6. Service de parasitologie-mycologie, groupe hospitalier Lariboisière-Saint-Louis, APHP, Paris. 7. Service de rhumatologie, Hôpital de Valence, Valence. 8. Service de rhumatologie, CHU, Angers. 9. Service de rhumatologie, Hôpital Robert Ballanger, Aulnay sous Bois. 10. Service d'infectiologie, Hôpital Charles Nicolle, Rouen. 11. Service de gastro-entérologie, Université Pierre et Marie Curie, Hôpital St Antoine, Paris. 12. Service de médecine Interne, CHU de Reims, Reims. 13. Université Paris Diderot, Sorbonne Paris Cité, UFR de médecine, Paris. 14. Institut de Veille Sanitaire, Saint Maurice Cedex. 15. APHP, hopital Bicêtre, Service de Rhumatologie, Le Kremlin Bicêtre; Université Paris-Sud, Le Kremlin Bicêtre, France; INSERM U1012, Le Kremlin Bicêtre, France. 16. Université Paris Descartes, Sorbonne Paris Cité, IHU Imagine, APHP, Hôpital Necker Enfants malades, Centre d'Infectiologie Necker Pasteur, Service de maladies infectieuses et tropicales, Paris. Electronic address: olivier.lortholary@nck.aphp.fr.
Abstract
OBJECTIVE: Our objective was to describe the incidence and risk factors of legionellosis associated with tumor necrosis factor (TNF)-α antagonist use. METHODS:From February 1, 2004, to January 31, 2007, we prospectively collected all cases of legionellosis among French patients receiving TNF-α antagonists in the Research Axed on Tolerance of Biotherapies (RATIO) national registry. We conducted an incidence study with the French population as a reference and a case-control analysis with four control subjects receiving TNF-α antagonists per case of legionellosis. RESULTS: Twenty-seven cases of legionellosis were reported. The overall annual incidence rate of legionellosis for patients receivingTNF-α antagonists, adjusted for age and sex, was 46.7 (95% CI, 0.0-125.7) per 100,000 patient-years. The overall standardized incidence ratio (SIR) was 13.1 (95% CI, 9.0-19.1; P < .0001) and was higher for patients receivinginfliximab (SIR, 15.3 [95% CI, 8.5-27.6; P < .0001]) or adalimumab (SIR, 37.7 [95% CI, 21.9-64.9; P < .0001]) than etanercept (SIR, 3.0 [95% CI, 1.00-9.2; P = .06]). In the case-control analysis, exposure to adalimumab (OR, 8.7 [95% CI, 2.1-35.1]) or infliximab (OR, 9.2 [95% CI, 1.9-45.4]) vs etanercept was an independent risk factor for legionellosis. CONCLUSIONS: The incidence rate of legionellosis for patients receivingTNF-α antagonists is high, and the risk is higher for patients receiving anti-TNF-α monoclonal antibodies than soluble TNF-receptor therapy. In case of pneumonia occurring during TNF-α antagonist therapy, specific urine antigen detection should be performed and antibiotic therapy should cover legionellosis. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00224562; URL: www.clinicaltrials.gov.
RCT Entities:
OBJECTIVE: Our objective was to describe the incidence and risk factors of legionellosis associated with tumornecrosis factor (TNF)-α antagonist use. METHODS: From February 1, 2004, to January 31, 2007, we prospectively collected all cases of legionellosis among French patients receiving TNF-α antagonists in the Research Axed on Tolerance of Biotherapies (RATIO) national registry. We conducted an incidence study with the French population as a reference and a case-control analysis with four control subjects receiving TNF-α antagonists per case of legionellosis. RESULTS: Twenty-seven cases of legionellosis were reported. The overall annual incidence rate of legionellosis for patients receiving TNF-α antagonists, adjusted for age and sex, was 46.7 (95% CI, 0.0-125.7) per 100,000 patient-years. The overall standardized incidence ratio (SIR) was 13.1 (95% CI, 9.0-19.1; P < .0001) and was higher for patients receiving infliximab (SIR, 15.3 [95% CI, 8.5-27.6; P < .0001]) or adalimumab (SIR, 37.7 [95% CI, 21.9-64.9; P < .0001]) than etanercept (SIR, 3.0 [95% CI, 1.00-9.2; P = .06]). In the case-control analysis, exposure to adalimumab (OR, 8.7 [95% CI, 2.1-35.1]) or infliximab (OR, 9.2 [95% CI, 1.9-45.4]) vs etanercept was an independent risk factor for legionellosis. CONCLUSIONS: The incidence rate of legionellosis for patients receiving TNF-α antagonists is high, and the risk is higher for patients receiving anti-TNF-α monoclonal antibodies than soluble TNF-receptor therapy. In case of pneumonia occurring during TNF-α antagonist therapy, specific urine antigen detection should be performed and antibiotic therapy should cover legionellosis. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00224562; URL: www.clinicaltrials.gov.
Authors: Catia Cillóniz; Antoni Torres; Michael Niederman; Menno van der Eerden; James Chalmers; Tobias Welte; Francesco Blasi Journal: Intensive Care Med Date: 2016-06-08 Impact factor: 17.440
Authors: Cyril Garrouste; Dany Anglicheau; Nassim Kamar; Claire Bachelier; Joseph Rivalan; Bruno Pereira; Sophie Caillard; Julien Aniort; Philippe Gatault; Martin Soubrier; Johnny Sayegh; Charlotte Colosio; Anthony Buisson; Eric Thervet; Nicolas Bouvier; Anne Elisabeth Heng Journal: Medicine (Baltimore) Date: 2016-10 Impact factor: 1.889