Dr. Curtis has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Pfizer, BMS, Crescendo, UCB, and AbbVie, and (more than $10,000 each) from Roche/Genentech, Janssen, CORRONA, and Amgen.
Risk of Hospitalized Bacterial Infections Associated With Biologic Treatment Among US Veterans With Rheumatoid Arthritis
Version of Record online: 26 JUN 2014
Copyright © 2014 by the American College of Rheumatology
Arthritis Care & Research
Volume 66, Issue 7, pages 990–997, July 2014
How to Cite
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, K. L., Burton, M. J., Kamauu, A. and Baddley, J. W. (2014), Risk of Hospitalized Bacterial Infections Associated With Biologic Treatment Among US Veterans With Rheumatoid Arthritis. Arthritis Care Res, 66: 990–997. doi: 10.1002/acr.22281
- Issue online: 26 JUN 2014
- Version of Record online: 26 JUN 2014
- Accepted manuscript online: 27 JAN 2014 01:51PM EST
- Manuscript Accepted: 7 JAN 2014
- Manuscript Received: 11 MAY 2013
- Agency for Healthcare Research and Quality. Grant Numbers: R01-HS-018517, 1U18-HS-016956
- NIH. Grant Number: AR-053351
- Agency for Healthcare Research and Quality. Grant Number: R01-HS018517
- Agency for Healthcare Research and Quality. Grant Number: U18-HS016956
- NIH/National Institute for Arthritis and Musculoskeletal and Skin Diseases. Grant Number: K24-AR052361
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 prednisone >7.5 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.