Rare Diseases Symptoms Automatic Extraction

Incidence and risk factors of Legionella pneumophila pneumonia during anti-tumor necrosis factor therapy: a prospective French study.

[legionellosis]

Our objective was to describe the incidence and risk factors of legionellosis associated with tumor necrosis factor (TNF)-α antagonist use.From February 1, 2004, to January 31, 2007, we prospectively collected all cases of legionellosis among French patients receiving TNF antagonists in the Research Axed on Tolerance of Biotherapies (RATIO) national registry. We conducted an incidence study with the French population as a reference and a case-control analysis with four control subjects receiving TNF antagonists per case of legionellosis.Twenty-seven cases of legionellosis were reported. The overall annual incidence rate of legionellosis for patients receiving TNF antagonists, adjusted for age and sex, was 46.7 (95% CI, 0.0-125.7) per 100,000 patient-years. The overall standardized incidence ratio (SIR) was 13.1 (95% CI, 9.0-19.1; P < .0001) and was higher for patients receiving infliximab (SIR, 15.3 [95% CI, 8.5-27.6; P < .0001]) or adalimumab (SIR, 37.7 [95% CI, 21.9-64.9; P < .0001]) than etanercept (SIR, 3.0 [95% CI, 1.00-9.2; P = .06]). In the case-control analysis, exposure to adalimumab (OR, 8.7 [95% CI, 2.1-35.1]) or infliximab (OR, 9.2 [95% CI, 1.9-45.4]) vs etanercept was an independent risk factor for legionellosis.The incidence rate of legionellosis for patients receiving TNF antagonists is high, and the risk is higher for patients receiving anti-TNF monoclonal antibodies than soluble TNF-receptor therapy. In case of pneumonia occurring during TNF antagonist therapy, specific urine antigen detection should be performed and antibiotic therapy should cover legionellosis.ClinicalTrials.gov; No.: NCT00224562; URL: www.clinicaltrials.gov.