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Physicians Split on Infection Risk of Immunomodulatory Medications
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A physician poll showed that experienced health care providers hold a broad range of opinions on the infection risks of anti-tumor necrosis factor medication, according to findings published in the Journal of Clinical Rheumatology.
The researchers also found that experienced physicians were more concerned than their less experienced peers regarding the risk of infection carried by intermediate doses of prednisone.
“Many immunomodulatory medications, particularly those that are immunosuppressive, carry an inherent risk of the development of certain infections; the risk of infection with each medication varies, depending on the medication’s mechanism of action,” Rebecca Sharim, MD, of the Hospital of the University of Pennsylvania, in Philadelphia, and colleagues wrote. “Although many studies have attempted to address the infection rates attributable to some of these medications, there is an overall lack of consistency in the literature.”
To determine how opinions and perceptions of the infection risks of multiple immunomodulatory treatments differ among physicians of various specialties and experience, the researchers distributed a survey to 634 health care providers at the Hospital of the University of Pennsylvania. The physicians — from the hospital’s internal medicine, family medicine, emergency medicine, rheumatology, dermatology, and infectious disease departments — rated 15 commonly used therapies on a scale of 0 to 100 based on immunosuppressant risk if hypothetically taken for 1 year.
A total of 197 physicians completed and returned the survey. A score of 0 meant “not at all concerned for a medication-related infection in the next year,” while a score of 100 indicated “extremely concerned for a medication-related infection in the next year.” An option indicating “I don’t know” was also provided for each treatment.
According to the researchers, experienced physicians differed from their less experienced peers in their risk assessment of prednisone doses of 10 mg to 20 mg (P = .046), hydroxychloroquine (P = .013), dapsone (P = .029), and anti–TNF therapy (P = .027). Among experienced physicians, 95% viewed dapsone as low risk, with 93% regarding hydroxychloroquine as low risk. In contrast, less experienced providers viewed both as medium- or high-risk treatments.
In addition, experienced physicians were more likely than less experienced providers to consider prednisone doses of 10 mg to 20 mg as medium- or high-risk. Among less experienced physicians, 55% said anti-TNF treatments carried a high risk for infection. Meanwhile, experienced providers even split their answers regarding anti-TNF therapies across low-, medium- and high-risk, the researchers found.
“This study encourages conversation about this challenging topic and sets the ground work for important future studies that could aid physicians in difficult patient care scenarios,” Sharim and colleagues wrote. “Future studies are needed to clarify the risk of infection with various immunomodulatory agents and summarize risks in a way that is easily accessible to physicians across medical specialties.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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