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.
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 tumornecrosis 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%, unspecifiedfungal 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.
Authors: Jasvinder A Singh; George A Wells; Robin Christensen; Elizabeth Tanjong Ghogomu; Lara Maxwell; John K Macdonald; Graziella Filippini; Nicole Skoetz; Damian Francis; Luciane C Lopes; Gordon H Guyatt; Jochen Schmitt; Loredana La Mantia; Tobias Weberschock; Juliana F Roos; Hendrik Siebert; Sarah Hershan; Michael Pt Lunn; Peter Tugwell; Rachelle Buchbinder Journal: Cochrane Database Syst Rev Date: 2011-02-16
Authors: Stanley W Chapman; William E Dismukes; Laurie A Proia; Robert W Bradsher; Peter G Pappas; Michael G Threlkeld; Carol A Kauffman Journal: Clin Infect Dis Date: 2008-06-15 Impact factor: 9.079
Authors: Mike van der Have; Bas Oldenburg; Herma H Fidder; Tim D G Belderbos; Peter D Siersema; Martijn G H van Oijen Journal: Dig Dis Sci Date: 2013-08-15 Impact factor: 3.199
Authors: John W Baddley; Kevin L Winthrop; Nivedita M Patkar; Elizabeth Delzell; Timothy Beukelman; Fenglong Xie; Lang Chen; Jeffrey R Curtis Journal: Emerg Infect Dis Date: 2011-09 Impact factor: 6.883
Authors: M A Huaman; R J Kryscio; C J Fichtenbaum; D Henson; E Salt; T R Sterling; B A Garvy Journal: Epidemiol Infect Date: 2017-02-16 Impact factor: 2.451
Authors: Michael Ke; Arash Heidari; Michael Valdez; Allen Tsiyer; Rasha Kuran; Royce Johnson Journal: J Investig Med High Impact Case Rep Date: 2022 Jan-Dec
Authors: Sasha R Fehily; Aysha H Al-Ani; Jonathan Abdelmalak; Clarissa Rentch; Eva Zhang; Justin T Denholm; Douglas Johnson; Siew C Ng; Vishal Sharma; David T Rubin; Peter R Gibson; Britt Christensen Journal: Aliment Pharmacol Ther Date: 2022-05-20 Impact factor: 9.524