TNF-α antagonist use and risk of hospitalization for infection in a national cohort of veterans with rheumatoid arthritis.

Lane MA, McDonald JR, Zeringue AL, Caplan L, Curtis JR, Ranganathan P, Eisen SA.

Abstract

Medications used to treat rheumatoid arthritis (RA) may confer an increased risk of infection. We conducted a retrospective cohort study of veterans with RA followed in the United States Department of Veterans Affairs health care system from October 1998 through September 2005. Risk of hospitalization for infection associated with tumor necrosis factor (TNF)-α antagonists therapy was measured using an extension of Cox proportional hazards regression, adjusting for demographic characteristics, comorbid illnesses, and other medications used to treat RA. A total of 20,814 patients met inclusion criteria, including 3796 patients who received infliximab, etanercept, or adalimumab. Among the study cohort, 1465 patients (7.0%) were hospitalized at least once for infection. There were 1889 hospitalizations for infection. The most common hospitalized infections were pneumonia, bronchitis, and cellulitis. Age and several comorbid medical conditions were associated with hospitalization for infection. Prednisone (hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.88-2.43) and TNF-α antagonist use (HR, 1.24; 95% CI, 1.02-1.50) were associated with hospitalization for infection, while the use of disease-modifying antirheumatic drugs (DMARDs) other than TNF-α antagonists was not. Compared to etanercept, infliximab was associated with risk for hospitalization for infection (HR, 1.51; 95% CI, 1.14-2.00), while adalimumab use was not (HR, 0.95; 95% CI, 0.68-1.33). In all treatment groups, rate of hospitalization for infection was highest in the first 8 months of therapy. We conclude that patients with RA who are treated with TNF-α antagonists are at higher risk for hospitalization for infection than those treated with other DMARDs. Prednisone use is also a risk factor for hospitalization for infection.

一项回顾性研究提示TNF拮抗剂增加感染住院风险

Lane MA, et al. Medicine (Baltimore). 2011;90(2):139-45.

用于治疗类风湿关节炎（RA）的药物可能导致感染风险增加。我们对患有RA的退伍军人进行了一项回顾性队列研究，这些病人信息保存于美国退伍军人事务部卫生保健系统，我们采集了1998年10月至2005年9月之间的相关信息。为评估TNF拮抗剂相关感染住院风险，我们采用了一种扩展型Cox比例风险回归分析，同时对人口统计学、共患病以及RA相关其它治疗进行校正。共计20814例病人符合本研究纳入条件，其中有3796例接受依那西普、英夫利昔单抗或阿达木单抗治疗。有1465例（7.0％）病人至少有一次因感染而住院，感染住院总例次共计1889起。最常见住院感染是肺炎、支气管炎和蜂窝组织炎。年龄和若干医疗状况与感染住院有关联。强的松（风险比[HR]为2.14; 95％置信区间[CI]为1.88-2.43）和TNF-alpha拮抗剂（HR为1.24; 95％CI为1.02-1.50）的使用均与感染住院相关，而应用DMARDs与感染住院关联性不大。与依那西普相比，使用英夫利昔单抗增加了感染住院风险（HR: 1.51; 95％CI: 1.14-2.00），而阿达木单抗未明显增加风险（HR: 0.95; 95％CI: 0.68-1.33）。在所有治疗组，头8个月的感染住院率最高。

由此，我们得出结论，接受TNF拮抗剂治疗的RA病人的感染住院风险高于DMARDs治疗。使用糖皮质激素也是感染住院的危险因素。