Risk of Hospitalized Bacterial Infections Associated with Biologic Treatment Among U.S. Veterans with Rheumatoid Arthritis
| Autor: | Curtis, J.R., Yang, S., Patkar, N. M., Chen, L., Singh, J. A., Cannon, G. W., Mikuls, T.R., Delzell, E., Saag, K.G., Safford, M.M., DuVall, S., Alexander, K., Napalkov, P., Winthrop, Kevin L, Burton, M.J., Kamauu, A., Baddley, J.W. |
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| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Male
Immunoconjugates Tumor Necrosis Factor-alpha Incidence Bacterial Infections Comorbidity Middle Aged Risk Assessment Article United States Abatacept Arthritis Rheumatoid Hospitalization Antibodies Monoclonal Murine-Derived Antirheumatic Agents Humans Female Rituximab Glucocorticoids Aged Retrospective Studies Veterans |
| ISSN: | 1998-2011 |
| Popis: | The comparative risk of infection associated with non-anti-tumor necrosis factor (anti-TNF) biologic agents is not well established. Our objective was to compare risk for hospitalized infections between anti-TNF and non-anti-TNF biologic agents in US veterans with rheumatoid arthritis (RA).Using 1998-2011 data from the US Veterans Health Administration, we studied RA patients initiating rituximab, abatacept, or anti-TNF therapy. Exposure was based upon days supplied (injections) or usual dosing intervals (infusions). Treatment episodes were defined as new biologic agent use. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for hospitalization for a bacterial infection were estimated from Cox proportional hazards models, adjusting for potential confounders.Among 3,152 unique RA patients contributing 4,158 biologic treatment episodes to rituximab (n = 596), abatacept (n = 451), and anti-TNF agents (n = 3,111), the patient mean age was 60 years and 87% were male. The most common infections were pneumonia (37%), skin/soft tissue (22%), urinary tract (9%), and bacteremia/sepsis (7%). Hospitalized infection rates per 100 person-years were 4.4 (95% CI 3.1-6.4) for rituximab, 2.8 (95% CI 1.7-4.7) for abatacept, and 3.0 (95% CI 2.5-3.5) for anti-TNF. Compared to etanercept, the adjusted rate of hospitalized infection was not different for adalimumab (HR 1.4, 95% CI 0.9-2.2), abatacept (HR 1.1, 95% CI 0.6-2.1), or rituximab (HR 1.4, 0.8-2.6), although it was increased for infliximab (HR 2.3, 95% CI 1.3-4.0). Infection risk was greater for those taking prednisone7.5 mg/day (HR 1.8, 95% CI 1.3-2.7) and in the highest quartile of C-reactive protein (HR 2.3, 95% CI 1.4-3.8) and erythrocyte sedimentation rate (HR 4.1, 95% CI 2.3-7.2) compared to the lowest quartile.In older, predominantly male US veterans with RA, the risk of hospitalized bacterial infections associated with rituximab or abatacept was similar to etanercept. |
| Databáze: | OpenAIRE |
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