Risk of Coccidioidomycosis Infection Among Individuals Using Biologic Response Modifiers, Corticosteroids, and Oral...

Area of Science:

• Rheumatology
• Infectious Diseases
• Pharmacology

Background:

• Biologic response modifiers (BRMs), corticosteroids, and oral small molecules (OSMs) are used to treat rheumatic and autoimmune diseases.
• Coccidioidomycosis is a fungal infection endemic to certain regions of the US.

Purpose of the Study:

• To investigate the association between BRM, corticosteroid, and OSM use and the risk of developing coccidioidomycosis.
• To assess this risk in US Medicare beneficiaries diagnosed with rheumatic or autoimmune diseases.

Main Methods:

• A retrospective cohort study utilized 2011-2016 US Medicare claims data.
• Identified beneficiaries in coccidioidomycosis-endemic areas with rheumatic/autoimmune diseases initiating BRMs, corticosteroids, or OSMs.
• Employed time-varying exposure variables and multivariable Cox proportional hazard regression with a 90-day lag period.

Main Results:

• Among 5,065 beneficiaries with rheumatic/autoimmune diseases, 107 were diagnosed with coccidioidomycosis (6.1 per 1,000 person-years).
• BRM users had a significantly increased risk (aHR 3.94), followed by corticosteroid users (aHR 2.29), compared to OSM users.
• The coccidioidomycosis incidence rate for OSM users was similar to non-users of these medications.

Conclusions:

• The incidence of coccidioidomycosis was low in this Medicare population.
• BRM and corticosteroid use are associated with a higher risk of coccidioidomycosis.
• Screening for coccidioidomycosis is advised for patients on BRMs and corticosteroids in endemic regions.