Coccidioides Serologic Screening Practices in Individuals With Rheumatic and Autoimmune Diseases

Author:

Wilson Debbie L.1,Kollampare Shubha2,Kwoh C. Kent3,Zhou Lili4,Ashbeck Erin L.4,Sudano Dominick3,Lupi Maria1,Miller Andrew1,Smith Kristy1,Lo‐Ciganic Wei‐Hsuan5ORCID

Affiliation:

1. University of Florida Gainesville

2. University of Arizona Tucson

3. University of Arizona and The University of Arizona Arthritis Center Tucson

4. The University of Arizona Arthritis Center Tucson

5. University of Pittsburgh, Pittsburgh, Pennsylvania, and Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System Gainesville Florida

Abstract

ObjectiveWe aimed to estimate Coccidioides serologic screening rates before initiation of biologic disease‐modifying antirheumatic drugs including tofacitinib (b/tsDMARDs), conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs), and/or noninhaled corticosteroids.MethodsThis retrospective cohort study used 2011 to 2016 US Medicare claims data and included beneficiaries with rheumatic or autoimmune disease residing in regions within Arizona, California, and Texas endemic for Coccidioides spp. with ≥1 prescription for a b/tsDMARD, csDMARD, and/or noninhaled corticosteroid. We estimated prior‐year serologic screening incidence before initiating b/tsDMARDs, csDMARD, and/or noninhaled corticosteroid.ResultsDuring 2012 to 2016, 4,331 beneficiaries filled 64,049 prescriptions for b/tsDMARDs, csDMARDs, and noninhaled corticosteroids. Arizona's estimated screening rate was 20.1% (95% confidence interval [95% CI] 14.5–25.7) in the year before prescription initiation for b/tsDMARDs, 8.1% (95% CI 6.5–9.7) before csDMARDs, and 6.9% (95% CI: 5.6–8.2) before corticosteroids. Screening rates for b/tsDMARDs (2.8%, 95% CI 0.0–6.7), csDMARDs (1.0%, 95% CI 0.0–2.0), and corticosteroids (0.8%, 95% CI: 0.4–1.1) were negligible in California and undetected in Texas. Adjusted screening rate before prescription for b/tsDMARDs in Arizona increased from 14.5% (95% CI 7.5–21.5) in 2012 to 26.7% (95% CI 17.6–35.8) in 2016. Rheumatologists prescribing b/tsDMARDs in Arizona screened more than other providers (20.9% [95% CI 13.9–27.9] vs 12.9% [95% CI 5.9–20.0]).ConclusionCoccidioides serologic screening rates among Medicare beneficiaries with rheumatic/autoimmune diseases on b/tsDMARDs, csDMARDs, and noninhaled corticosteroids was low in Coccidioides spp.–US endemic regions between 2012 and 2016. Alignment of screening recommendations and clinical practice is needed.

Publisher

Wiley

Reference41 articles.

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2. Coccidioidomycosis

3. Increase in reported coccidioidomycosis–United States, 1998‐2011;Centers for Disease Control and Prevention (CDC);MMWR Morb Mortal Wkly Rep,2013

4. Valley fever (coccidioidomycosis) statistics2022.Centers for Disease Control and Prevention. Updated July11 2022. Accessed May 8 2023.https://www.cdc.gov/fungal/diseases/coccidioidomycosis/statistics.html

5. Valley fever 2021 annual report. Arizona Department of Health Services.2021. Accessed May 8 2023.https://www.azdhs.gov/documents/preparedness/epidemiology‐disease‐control/valley‐fever/reports/valley‐fever‐2021.pdf?utm_medium=email&utm_source=govdelivery

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