{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:20:21Z","timestamp":1789154421209,"version":"build-2803163510"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Invasive fungal and nontuberculous mycobacterial (NTM) infections are important complications following TNF-\u03b1 inhibitor initiation, but the contribution of additional immunosuppressive medication exposure remains incompletely defined. We evaluated their incidence and spectrum and associations with time-varying immunosuppressive medication exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using Merative MarketScan data (2018\u20132022) among adults initiating TNF-\u03b1 inhibitors. Invasive fungal and NTM infections were identified using ICD-10-CM codes. Systemic glucocorticoid and non-glucocorticoid immunosuppressant exposures were modeled as time-varying variables. Cox proportional hazards models evaluated associations between immunosuppressive medication exposure and infection risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 62,772 adults, 238 (0.4%) developed an invasive fungal or NTM infection after a median of 14.6 months, corresponding to 146 per 100,000 person-years. Histoplasmosis (26%), NTM infections (22%), and coccidioidomycosis (16%) were most common. In time-varying analyses, glucocorticoid exposure alone (aHR 1.77, 95% CI 1.24\u20132.52) and non-glucocorticoid immunosuppressant exposure alone (aHR 2.25, 95% CI 1.43\u20133.52) were associated with higher infection risk compared with periods without either exposure. Combined exposure was not associated with infection risk (aHR 1.31, 95% CI 0.92\u20131.85).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Invasive fungal and NTM infections were uncommon following TNF-\u03b1 inhibitor initiation. Time-varying glucocorticoid and non-glucocorticoid immunosuppressant exposures were associated with higher infection risk, illustrating the importance of dynamic immunosuppressive medication exposure when assessing infection risk during longitudinal care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-026-02961-1","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:40:11Z","timestamp":1788172811000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Immunosuppressive medication exposure and risk of invasive fungal and nontuberculous mycobacterial infections following TNF-\u03b1 inhibitor initiation: a time-varying analysis"],"prefix":"10.1007","author":[{"given":"Alexander J.","family":"Ruehman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7279-4418","authenticated-orcid":false,"given":"Shaimaa","family":"Elshafie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4842-7551","authenticated-orcid":false,"given":"Mohammed","family":"Zuber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3821-4595","authenticated-orcid":false,"given":"Lorenzo Villa","family":"Zapata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7363-8652","authenticated-orcid":false,"given":"Andr\u00e9s F.","family":"Henao-Mart\u00ednez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4018-0195","authenticated-orcid":false,"given":"Daniel B.","family":"Chastain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"2961_CR1","doi-asserted-by":"publisher","unstructured":"Jang DI, Lee AH, Shin HY, Song HR, Park JH, Kang TB, et al. 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