Incidence and risk factors of Legionella pneumophila pneumonia during anti-Tumor Necrosis Factor therapy: a prospective French study

Publié le 2 septembre 2013
Mis à jour le 6 septembre 2019

OBJECTIVE: Our objective here was to describe the incidence and risk factors of legionellosis associated with TNF-± antagonist use. METHODS: 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 4 controls receiving TNF-± antagonists per case of legionellosis. RESULTS: 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% confidence interval [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<0.0001) and was higher for patients receiving infliximab (SIR 15.3 [95% CI 8.5-27.6; p<0.0001]) or adalimumab (SIR 37.7 [95% CI 21.9-64.9, p<0.0001]) than etanercept (SIR 3.0 [95% CI 1.00-9.2, p=0.06]). In the case-control analysis, exposure to adalimumab (odds ratio [OR] 8.7 [95% CI 2.1-35.1]) or infliximab (OR 9.2 [95% CI 1.9-45.4]) versus etanercept was an independent risk factor for legionellosis. CONCLUSION: 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. (R.A.)

Auteur : Lanternier F, Tubach F, Ravaud P, Salmon D, Dellamonica P, Bretagne S, Couret M, Bouvard B, Debandt M, Gueit I, Gendre JP, Leone J, Nicolas N, Che D, Mariette X, Lortholary O
Chest, 2013, vol. 144, n°. 3, p. 990-8