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Contribution of Biologic Response Modifiers to the Risk of Coccidioidomycosis Severity

Fariba M Donovan1,2, Ferris A Ramadan3, James R Lim2

  • 1Valley Fever Center for Excellence, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA.

Open Forum Infectious Diseases
|February 16, 2022
PubMed
Abstract

Insights

Biologic response modifiers (BRMs) do not worsen coccidioidomycosis (CM) presentations in autoimmune disease (AI) patients. However, BRMs significantly increase the risk of disseminated CM (DCM) in these individuals.

Area of Science:

  • Infectious Diseases
  • Rheumatology
  • Immunology

Background:

  • Coccidioidomycosis (CM) poses a severe risk to immunosuppressed individuals.
  • The safety of biologic response modifiers (BRMs) for autoimmune disease (AI) patients in CM-endemic areas is not well-established.
  • This study investigates the risk of CM and disseminated CM (DCM) in AI patients treated with BRMs in Arizona.

Purpose of the Study:

  • To determine the risk of CM and DCM in patients with AI treated with BRMs.
  • To assess the association between BRM use and CM severity in AI patients.
  • To identify potential risk factors for severe CM outcomes in this population.

Main Methods:

  • Retrospective study of electronic medical records from October 2017 to December 2019 in Tucson and Phoenix.
  • Inclusion criteria: patients ≥18 years old with ICD-10 codes for both CM and AI.
  • Data collected: demographics, residency, AI diagnoses, CM presentation, and BRM treatments.

Main Results:

  • Of 944 charts reviewed, 138 patients had confirmed CM and AI diagnoses.
  • Male sex and African ancestry were associated with increased CM and DCM risk, respectively.
  • BRM use was associated with a 2.4-fold increased risk of DCM compared to pulmonary CM (PCM).

Conclusions:

  • AI itself does not alter CM clinical presentation.
  • BRM treatment for AI patients does not generally lead to severe CM.
  • BRMs significantly elevate the risk of DCM, necessitating further research into susceptible immunogenetic subsets.
Keywords:
Valley feverautoimmune diseasebiologic response modifierscoccidioidomycosistumor necrosis factor inhibitors

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