RT Journal Article
SR Electronic
T1 The comparative risk of serious infections among rheumatoid arthritis patients starting or switching biological agents
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 1401
OP 1406
DO 10.1136/ard.2010.146365
VO 70
IS 8
A1 Jeffrey R Curtis
A1 Fenglong Xie
A1 Lang Chen
A1 John W Baddley
A1 Timothy Beukelman
A1 Kenneth G Saag
A1 Claire Spettell
A1 Raechele M McMahan
A1 Joaquim Fernandes
A1 Kevin Winthrop
A1 Elizabeth Delzell
YR 2011
UL http://ard.bmj.com/content/70/8/1401.abstract
AB Background It is unclear whether anti-tumour necrosis factor alpha and biological agents with different mechanisms of action have similar safety. This study evaluated the incidence of hospitalised infections among rheumatoid arthritis (RA) patients starting or switching various biological agents. Methods Using a database from a large US healthcare organisation from January 2005 to August 2009, the authors identified enrollees with RA and their treatment episodes entailing the new use of a biological agent, stratified by no biological use in the previous year (‘biological-free’) or switching from a different biological agent (‘switchers’). Outcomes were hospitalised infections identified using previously validated algorithms. Proportional hazards models estimated the hazard ratio of hospitalised infections, comparing each biological agent with infliximab. Results Among 7847 biological treatment episodes, 63% were for biological-free patients and 37% for switchers. There were 364 hospitalised infections. Rates of hospitalised infection among biological-free patients and switchers were 4.6 and 7.0 per 100 person-years, respectively (p<0.0001). After multivariable adjustment controlling for biological-free/switcher status and other infection-related factors and compared with infliximab, users of abatacept (HR 0.68, 95% CI 0.48 to 0.96), adalimumab (HR 0.52, 0.39 to 0.71), etanercept (HR 0.64, 0.49 to 0.84) and rituximab (HR 0.81, 0.55 to 1.20) had lower rates of hospitalised infection. Patient risk factors contributed more to the risk of infection than did the risk associated with specific biological therapies. Conclusion The rate of hospitalised infections among RA patients was highest for infliximab. Most of the variability in patients' risk of infection was driven by factors other than biological agent exposure.