Journal of Epidemiology and Global Health

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Volume 8, Issue 3-4, December 2018, Pages 176 - 182

The Effect of a Regimen of Antifungal Cream Use on Episodes of Acute Adenolymphangitis (ADL) among Lymphedema Patients: An Application Using Marginal Structural Models

Authors
K.E. Mues1, *, M. Klein2, D.G. Kleinbaum2, W.D. Flanders2, L.M. Fox3
1Department of Epidemiology, Rollins School of Public Health & Laney Graduate School, Emory University, 1518 Clifton Rd., MS 1518-002-4AA (SPH: Epidemiology), Atlanta, GA 30322, United States
2Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States
3Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS A-06, Atlanta, GA 30329-4027, United States
* Corresponding author. Email: kmues@amgen.com
Corresponding Author
K.E. Mues
Received 14 December 2016, Accepted 25 October 2017, Available Online 31 December 2018.
DOI
10.2991/j.jegh.2017.10.009How to use a DOI?
Keywords
Lymphatic filariasis; lymphedema management; adenolymphangitis; marginal structural models; time-varying confounding
Abstract

Episodes of adenolymphangitis (ADL) are a recurrent clinical aspect of lymphatic filariasis (LF) and a risk factor for progression of lymphedema. Inter-digital entry lesions, often found on the web spaces between the toes of those suffering from lymphedema, have been shown to contribute to the occurrence of ADL episodes. Use of antifungal cream on lesions is often promoted as a critical component of lymphedema management. Our objective was to estimate the observed effect of antifungal cream use on ADL episodes according to treatment regimen among a cohort of lymphedema patients enrolled in a morbidity management program. We estimated this effect using marginal structural models for time varying confounding. In this longitudinal study, we estimate that for every one-unit increase in the number of times one was compliant to cream use through 12 months, there was a 23% (RR = 0.77 (0.62, 0.96)) decrease in the number of ADL episodes at 18 months, however the RR’s were not statistically significant at other study time points. Traditionally adjusted models produced a non-significant RR closer to the null at all time points. This is the first study to estimate the effect of a regimen of antifungal cream on the frequency of ADL episodes. This study also highlights the importance of the consideration and proper handling of time-varying confounders in longitudinal observational studies.

Copyright
© 2018 Atlantis Press International B.V.
Open Access
This is an open access article under the CC BY-NC license (http://creativecommons.org/licences/by-nc/4.0/).

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Journal
Journal of Epidemiology and Global Health
Volume-Issue
8 - 3-4
Pages
176 - 182
Publication Date
2018/12/31
ISSN (Online)
2210-6014
ISSN (Print)
2210-6006
DOI
10.2991/j.jegh.2017.10.009How to use a DOI?
Copyright
© 2018 Atlantis Press International B.V.
Open Access
This is an open access article under the CC BY-NC license (http://creativecommons.org/licences/by-nc/4.0/).

Cite this article

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TY  - JOUR
AU  - K.E. Mues
AU  - M. Klein
AU  - D.G. Kleinbaum
AU  - W.D. Flanders
AU  - L.M. Fox
PY  - 2018
DA  - 2018/12/31
TI  - The Effect of a Regimen of Antifungal Cream Use on Episodes of Acute Adenolymphangitis (ADL) among Lymphedema Patients: An Application Using Marginal Structural Models
JO  - Journal of Epidemiology and Global Health
SP  - 176
EP  - 182
VL  - 8
IS  - 3-4
SN  - 2210-6014
UR  - https://doi.org/10.2991/j.jegh.2017.10.009
DO  - 10.2991/j.jegh.2017.10.009
ID  - Mues2018
ER  -