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

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

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


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.

Original languageEnglish
Pages (from-to)597-603
Number of pages7
JournalArthritis and Rheumatology
Issue number3
StatePublished - Mar 1 2016

Bibliographical note

Funding Information:
Drs. Salt and Huaman's work was supported in part by the National Center for Research Resources (NCRR) and the National Center for Advancing Translational Sciences, NIH (grant UL1-TR-000117). Access to the large commercially insured data set was made available with funding from the Clinical and Translational Science Award Consortium, NCRR, NIH (grant UL1-TR-000117).

Publisher Copyright:
© 2016, American College of Rheumatology.

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology


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