Management of coccidioidomycosis in patients receiving biologic response modifiers or disease-modifying antirheumatic drugs
Arthritis Care & Research , 06/29/2012
Clinical Article
Taroumian S et al. – Retreating rheumatic disease patients with a biologic response modifier (BRM) and/or disease–modifying antirheumatic drug (DMARD) after coccidioidomycosis appears to be safe in some patients. The authors propose a management strategy based on coccidioidomycosis disease activity.
Methods- A retrospective chart review identified patients who developed coccidioidomycosis during treatment with DMARDs or BRMs.
- Patients were seen at least once in a University–affiliated or Veterans Administration outpatient rheumatology clinic in Tucson, Arizona between 2007 and 2009.
- Forty–four patients were identified.
- Rheumatologic treatment included BRM alone (11), DMARD alone (8), or combination therapy (25).
- Manifestations of coccidioidomycosis included pulmonary infection (29), disseminated disease (9), and asymptomatic positive coccidioidal serologies (6).
- After the diagnosis of coccidioidomycosis, 26 patients had BRMs and DMARDs stopped, 8 patients had BRM stopped but DMARD therapy continued, and 10 patients had no change in their immunosuppressive therapy.
- Forty–one patients had antifungal therapy initiated for 1 month or longer.
- Follow–up data were available for 38 patients.
- BRM and/or DMARD therapy was continued or resumed in 33 patients only 16 of which continued concurrent antifungal therapy.
- None have had subsequent dissemination or complications of coccidioidomycosis.
