For a study, it was determined that when making medical decisions, physicians of all specialties had to consider the risk of infection when treating patients who were using immunomodulatory medicines. The researchers investigated how physicians’ views of the infection risk of immunomodulatory drugs differed according to specialization and amount of experience. A survey was issued to physicians from one tertiary care institution’s departments of internal medicine, family medicine, emergency medicine, rheumatology, dermatology, and infectious disease. Physicians rated their degree of worry about the risk of infection from 15 regularly used immunomodulatory medicines used for a year in a hypothetical scenario.
The survey was given to 634 persons, with 197 doctors responding. For 8 of the 15 drugs, opinions on the risk of infection differed considerably by specialization. Prednisone 10 to 20 mg (P = 0.046), hydroxychloroquine (P = 0.013), dapsone (P = 0.029), and anti-tumor necrosis factor (TNF) treatment (P = 0.027) were all appraised differently by experienced and less experienced clinicians in terms of infection risk. Dapsone (95%) and hydroxychloroquine (93%) were rated as low-risk drugs by most experienced doctors, but they were rated as a medium- or high-risk by many less experienced doctors. Prednisone 10 to 20 mg, on the other hand, was more likely to be classified as medium or high risk by experienced doctors. Anti-TNF therapy was deemed high risk by the majority of less experienced physicians (55%), but low, medium, and high risk by experienced physicians.
The danger of infection from several immunomodulatory drugs was seen differently by physicians. Experienced physicians were more concerned about the danger of infection from intermediate doses of prednisone than their colleagues. Even among seasoned clinicians, opinions on anti-TNF treatment varied widely.