{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:46:24Z","timestamp":1790178384616,"version":"4.1.0"},"reference-count":9,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"F2G, Inc."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Background: Disseminated coccidioidomycosis (DCM) often requires prolonged antifungal therapy (AFT). Real-world data on AFT duration in DCM are limited. We evaluated time to AFT discontinuation among patients with DCM in the United States clinical practice. Methods: This retrospective, longitudinal study used STATinMED data (2016\u20132024). Patients had \u22651 International Classification of Diseases, Tenth Revision (ICD-10) code for DCM (B38.3, B38.4, B38.7, B38.81) during January 2017\u2013December 2023, \u22651 claim for a triazole or amphotericin B within 21 days of the DCM diagnosis (index date), and continuous medical\/pharmacy coverage during the 6-month baseline period. Discontinuation was defined as a \u226521-day gap without AFT. Antifungal agent\/formulation switches were not considered discontinuations unless accompanied by a qualifying gap. The Kaplan\u2013Meier methods were used to estimate time to discontinuation. Results: We identified 991 patients with DCM. Median age was 52 years (IQR 36, 65); 60.0% were men. Most resided in California (42.8%) or Arizona (33.6%). Initial AFT consisted predominantly of triazoles (96.8%), primarily fluconazole (83.2%). Discontinuation occurred in 27.6%, 40.0%, 54.2%, and 68.0% of patients by 3, 6, 12, and 36 months. Median AFT duration was 9.9 months. Conclusions: In a large US claims cohort, there was substantial variability in AFT duration in routine practice. Many patients had AFT durations under the lower limit of guideline recommendations for DCM, suggesting potential under-treatment, though appropriate clinical justifications may have existed.<\/jats:p>","DOI":"10.3390\/jof12040293","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T13:22:47Z","timestamp":1776691367000},"page":"293","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Duration of Antifungal Therapy in Disseminated Coccidioidomycosis Patients: A Real-World Treatment Utilization Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4868-7158","authenticated-orcid":false,"given":"Craig I.","family":"Coleman","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT 06269-3092, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9986-2326","authenticated-orcid":false,"given":"Belinda","family":"Lovelace","sequence":"additional","affiliation":[{"name":"Health Economics and Outcomes Research, F2G, Inc., Princeton, NJ 08540, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bresnik","sequence":"additional","affiliation":[{"name":"Clinical Research and Development, F2G, Inc., Princeton, NJ 08540, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (CDC) (2026, February 01). Reported Cases of Valley Fever, Available online: https:\/\/www.cdc.gov\/valley-fever\/php\/statistics\/index.html."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e112","DOI":"10.1093\/cid\/ciw360","article-title":"2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis","volume":"63","author":"Galgiani","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","unstructured":"(2025, October 09). STATinMED Fact Sheet: RWD Insights, Powered by STATinMED. Available online: https:\/\/statinmed.com\/wp-content\/uploads\/2023\/02\/STATinMED_FactSheet_RWD_FEB2023.pdf."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"882","DOI":"10.3201\/eid3005.231624","article-title":"Coccidioidomycosis-Related Hospital Visits, Texas, USA, 2016\u20132021","volume":"30","author":"Mayfield","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e0146525","DOI":"10.1128\/aac.01465-25","article-title":"Insights into current coccidioidomycosis therapeutic pathways","volume":"69","author":"Edwards","year":"2025","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1097\/MLR.0b013e31829b1d2a","article-title":"Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases","volume":"51","author":"Raebel","year":"2013","journal-title":"Med. Care"},{"key":"ref_8","first-page":"215","article-title":"Administrative Databases and Outcomes Assessment: An Overview of Issues and Potential Utility","volume":"5","author":"Gandhi","year":"1999","journal-title":"J. Manag. Care Pharm."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"myaf091","DOI":"10.1093\/mmy\/myaf091","article-title":"Misuse of the unspecified coccidioidomycosis diagnosis code: An audit of electronic health records","volume":"63","author":"Coleman","year":"2025","journal-title":"Med. Mycol."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/12\/4\/293\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T14:15:41Z","timestamp":1776694541000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/12\/4\/293"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":9,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jof12040293"],"URL":"https:\/\/doi.org\/10.3390\/jof12040293","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,20]]}}}