Increased risk of coccidioidomycosis in patients treated with TNF-alpha antagonists

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Arthritis Rheum. 2004 Jun;50(6):1959-66.

Increased risk of coccidioidomycosis in patients treated with tumor

necrosis factor alpha antagonists.

Bergstrom L, Yocum DE, Ampel NM, Villanueva I, Lisse J, Gluck O, Tesser

J, Posever J, M, Araujo J, Kageyama DM, Berry M, Karl L, Yung CM.

University of Arizona, Tucson, 85724, USA. laurieb@...

OBJECTIVE: To describe a group of patients who were treated with tumor

necrosis factor alpha (TNF alpha) antagonists and who developed

coccidioidomycosis, and to test the hypothesis that patients with

inflammatory arthritis receiving TNF alpha antagonist therapy are at

higher risk for developing symptomatic coccidioidomycosis. METHODS:

Cases of coccidioidomycosis were identified and reviewed from among

patients receiving TNF alpha antagonist therapy from May 1998 through

February 2003 in 5 practices within the areas endemic for

coccidioidomycosis (Arizona, California, and Nevada). In addition, the

relative risk of developing symptomatic coccidioidomycosis was

calculated in patients with inflammatory arthritis who were receiving

treatment with infliximab, in comparison with patients with inflammatory

arthritis who were not receiving infliximab, from January 2000 to

February 2003 in a single medical center. RESULTS: Thirteen cases of

documented coccidioidomycosis were associated with TNF alpha antagonist

therapy. Twelve cases were associated with the use of infliximab and 1

case with etanercept. Among the cohort of patients from a single medical

center, 7 of the 247 patients receiving infliximab and 4 of the 738

patients receiving other therapies developed symptomatic

coccidioidomycosis (relative risk 5.23, 95% confidence interval

1.54-17.71; P < 0.01).

CONCLUSION: Patients with inflammatory arthritis who are undergoing

treatment with infliximab appear to be at higher risk for developing

symptomatic coccidioidomycosis as compared with those not receiving

infliximab.

PMID: 15188373

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