Objectives To evaluate incidence of clinically significant infections in RA patients treated with various RA therapies.
Methods Retrospective analysis of linked medical and outpatient pharmacy claims from 10/98–9/99 was conducted using a large managed care database (Protocare Sciences). Patients age 35 and older, having at least 2 claims more than 20 days apart with an ICD-9CM diagnosis for RA were selected for analysis. RA therapies, including anti-inflammatory agents, steroids, DMARDS, and other systemic anti-arthritic agents were classified and clinically significant infections were identified. Comparisons of infection rates between various therapies were assessed using Incidence Density Ratios.
Results Most of the 2,443 RA patients (86%) received drug therapy specific for RA during the study period. Overall, 1,207 patients (49%) had at least one infection, 783 patients (32%) had at least one upper Respiratory Infection (RI), and 716 patients (29%) had at least one non-RI. A greater proportion of patients who received direct RA therapy experienced an upper RI compared to those patients who did not (32.8% vs. 27.8%). Patients had a statistically higher occurrence of infections for pneumonia and bronchitis during use of potentially immunomodulating therapy (IMT). Subgroup analysis of patients receiving IMT by steroid exposure is presented Table 1. Incidence Density Ratios (95% CI):
Conclusion Infections were common in patients on RA therapies with nearly half of all patients experiencing at least one infection during the 12 months studied. Selection of therapy associated with infections should be considered in the overall management of patients with rheumatoid arthritis.
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