Dr. Michael Saag has received grants and/or research support (less than $10,000 each) from Achillion Pharmaceutica, Boehringer-Ingelheim, Gilead Sciences, GlaxoSmithKline, Merck, Panacos, Pfizer/Agouron, Progenics, Roche, Serono, Tibotec, Trimeris, and Vertex. He has received consulting fees (less than $10,000 each) from Achillion Pharmaceutica, Avexa, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck, Monogram Biosciences, Panacos, Pfizer/Agouron, Progenics, Roche, Tanox, Tibotec/Virco, Trimeris, and Vertex. He has received speaking fees (less than $10,000 each) from all of the above. He has received consulting fees and/or speaking fees (more than $10,000 each) from Bristol-Myers Squibb and GlaxoSmithKline.
Risk of serious bacterial infections among rheumatoid arthritis patients exposed to tumor necrosis factor α antagonists
Article first published online: 28 MAR 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 56, Issue 4, pages 1125–1133, April 2007
How to Cite
Curtis, J. R., Patkar, N., Xie, A., Martin, C., Allison, J. J., Saag, M., Shatin, D. and Saag, K. G. (2007), Risk of serious bacterial infections among rheumatoid arthritis patients exposed to tumor necrosis factor α antagonists. Arthritis & Rheumatism, 56: 1125–1133. doi: 10.1002/art.22504
- Issue published online: 28 MAR 2007
- Article first published online: 28 MAR 2007
- Manuscript Accepted: 4 JAN 2007
- Manuscript Received: 30 SEP 2006
- the Maryland Chapter of the Arthritis Foundation
- the Agency for Healthcare Research and Quality. Grant Number: HS-10389
- NIH. Grant Number: K24-AR-052361-01 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and grant AR-47512-03
To evaluate the risk of serious bacterial infections associated with tumor necrosis factor α (TNFα) antagonists among rheumatoid arthritis (RA) patients.
A retrospective cohort study of US RA patients enrolled in a large health care organization identified patients who received either TNFα antagonists or methotrexate (MTX). Administrative data were used to identify hospitalizations with possible bacterial infections; corresponding medical records were abstracted and reviewed by infectious disease specialists for evidence of definite infections. Proportional hazards models evaluated time-dependent infection risks associated with TNFα antagonists.
Hospital medical records with claims-identified suspected bacterial infections were abstracted (n = 187) among RA patients who received TNFα antagonists (n = 2,393; observation time 3,894 person-years) or MTX (n = 2,933; 4,846 person-years). Over a median followup time of 17 months, the rate of hospitalization with a confirmed bacterial infection was 2.7% among the patients treated with TNFα antagonists compared with 2.0% among the patients treated with MTX only. The multivariable-adjusted hazard ratio (HR) of infection among the patients who received TNFα antagonists was 1.9 (95% confidence interval [95% CI] 1.3–2.8) compared with patients who received MTX only. The incidence of infections was highest within 6 months after initiating TNFα antagonist therapy (2.9 versus 1.4 infections per 100 person-years; multivariable-adjusted HR 4.2, 95% CI 2.0–8.8).
The multivariable-adjusted risk of hospitalization with a physician-confirmed definite bacterial infection was ∼2-fold higher overall and 4-fold higher in the first 6 months among patients receiving TNFα antagonists versus those receiving MTX alone. RA patients were at increased risk of serious infections, irrespective of the method used to define an infectious outcome. Patients and physicians should vigilantly monitor for signs of infection when using TNFα antagonists, particularly shortly after treatment initiation.