Histoplasmosis Complicating Tumor Necrosis Factor–α Blocker Therapy: A Retrospective Analysis of 98 Cases
Year: 2015
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Histoplasmosis may complicate tumor necrosis factor (TNF)-α blocker therapy. Published case series provide limited guidance on disease management. We sought to determine the need for long-term antifungal therapy and the safety of resuming TNF-α blocker therapy after successful treatment of histoplasmosis. METHODS: We conducted a multicenter retrospective review of 98 patients diagnosed with histoplasmosis between January 2000 and June 2011. Multivariate logistic regression was used to evaluate risk factors for severe disease. RESULTS: The most commonly used biologic agent was infliximab (67.3%). Concomitant corticosteroid use (odds ratio [OR], 3.94 [95% confidence interval {CI}, 1.06-14.60]) and higher urine Histoplasma antigen levels (OR, 1.14 [95% CI, 1.03-1.25]) were found to be independent predictors of severe disease. Forty-six (47.4%) patients were initially treated with an amphotericin B formulation for a median duration of 2 weeks. Azole treatment was given for a median of 12 months. TNF-α blocker therapy was initially discontinued in 95 of 98 (96.9%) patients and later resumed in 25 of 74 (33.8%) patients at a median of 12 months (range, 1-69 months). The recurrence rate was 3.2% at a median follow-up period of 32 months. Of the 3 patients with recurrence, 2 had restarted TNF-α blocker therapy, 1 of whom died. Mortality rate was 3.2%. CONCLUSIONS: In this study, disease outcomes were generally favorable. Discontinuation of antifungal treatment after clinical response and an appropriate duration of therapy, probably at least 12 months, appears safe if pharmacologic immunosuppression has been held. Resumption of TNF-α blocker therapy also appears safe, assuming that the initial antifungal therapy was administered for 12 months.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/civ299
Authors: Paschalis Vergidis, Robin K. Avery, L. Joseph Wheat, Jennifer L. Dotson, Maha A. Assi, Smyrna A. Antoun, Kassem A. Hamoud, Steven D. Burdette, Alison G. Freifeld, David S. McKinsey, Mary E. Money, Thein Myint, David R. Andes, Cynthia A. Hoey, Daniel A. Kaul, Jana K. Dickter, David E. Liebers, Rachel A. Miller, William E. Muth, Vidhya Prakash, Frederick T. Steiner, Randall C. Walker, Chadi A. Hage
Institutions: University of Pittsburgh, Johns Hopkins University, Johns Hopkins Hospital, Nationwide Children's Hospital, University of Kansas, University of Kansas Medical Center, Wright State University, University of Nebraska Medical Center, University of Kentucky, University of Wisconsin–Madison, University of Michigan, Michigan Medicine, Kaiser Permanente, Kaiser Permanente Fontana Medical Center, Ellis Hospital, University of Iowa, Samaritan Health Services, SIU Medicine, Indiana University Health, Ball Memorial Hospital, Mayo Clinic, Indiana University Indianapolis
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2111855467