Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment

Authors

  • Timothy Beukelman,

    Corresponding author
    1. University of Alabama at Birmingham
    • University of Alabama at Birmingham, Division of Pediatric Rheumatology, 1600 7th Avenue South, CPP 210, Birmingham, AL 35233-1711
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    • Dr. Beukelman has received consulting fees, speaking fees, and/or honoraria from Novartis (less than $10,000) and a research grant from Pfizer.

  • Fenglong Xie,

    1. University of Alabama at Birmingham
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  • Lang Chen,

    1. University of Alabama at Birmingham
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  • John W. Baddley,

    1. University of Alabama at Birmingham
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    • Dr. Baddley has received consulting fees, speaking fees, and/or honoraria from Abbott and Merck (less than $10,000 each).

  • Elizabeth Delzell,

    1. University of Alabama at Birmingham
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    • A portion of Dr. Delzell's salary was funded by a contract from Amgen.

  • Carlos G. Grijalva,

    1. Vanderbilt University, Nashville, Tennessee
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  • James D. Lewis,

    1. University of Pennsylvania, Philadelphia
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    • Dr. Lewis has received consulting fees, speaking fees, and/or honoraria from Pfizer, Abbott, and Millennium (less than $10,000 each) and a research grant from Centocor.

  • Rita Ouellet-Hellstrom,

    1. FDA, Silver Spring, Maryland
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  • Nivedita M. Patkar,

    1. University of Alabama at Birmingham
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  • Kenneth G. Saag,

    1. University of Alabama at Birmingham
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    • Dr. Saag has received consulting fees, speaking fees, and/or honoraria from Eli Lilly, Merck, Novartis, Savient, Ardea, Regeneron, URL, and Abbott (less than $10,000 each) and from Amgen (more than $10,000).

  • Kevin L. Winthrop,

    1. Oregon Health and Science University, Portland
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    • Dr. Winthrop has received consulting fees, speaking fees, and/or honoraria from Amgen, Genentech, Abbott, and Wyeth (less than $10,000 each).

  • Jeffrey R. Curtis,

    1. University of Alabama at Birmingham
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    • Dr. Curtis has received consulting fees, speaking fees, and/or honoraria from Abbott, Bristol-Myers Squibb, Crescendo, and Pfizer (less than $10,000 each) and from Roche/Genentech, UCB, Centocor, the Consortium of Rheumatology Researchers of North America, and Amgen (more than $10,000 each).

  • on behalf of the SABER Collaboration

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    • See Appendix A for additional members of the Safety Assessment of Biological Therapeutics (SABER) Collaboration and their locations.


  • Statements contained herein should not be construed as endorsement by the Agency for Healthcare Research and Quality, the FDA, or the US Department of Health and Human Services.

Abstract

Objective

To compare the incidence of hospitalized bacterial infections among children with and children without juvenile idiopathic arthritis (JIA) and to examine the effects of selected medications.

Methods

Using national Medicaid data from 2000 through 2005, we identified a cohort of children with JIA and a comparator cohort of children with attention deficit hyperactivity disorder (ADHD). Exposures to methotrexate (MTX), TNF inhibitors, and oral glucocorticoids (GCs) were determined using pharmacy claims. Patients hospitalized with bacterial infections were identified using coded discharge diagnoses. We calculated adjusted hazard ratios (HRadj) to compare infection incidence rates while adjusting for relevant covariates.

Results

We identified 8,479 JIA patients with 13,003 person-years of followup; 36% took MTX and 16% took TNF inhibitors. Compared with ADHD patients, JIA patients who were not currently taking MTX or TNF inhibitors had an increased rate of infection (HRadj 2.0 [95% confidence interval (95% CI) 1.5, 2.5]). Among JIA patients not receiving TNF inhibitor therapy, MTX users had a similar rate of infection as those not currently taking MTX (HRadj 1.2 [95% CI 0.9, 1.7]). TNF inhibitor use (irrespective of MTX) resulted in a similar rate of infection as use of MTX without a TNF inhibitor (HRadj 1.2 [95% CI 0.8, 1.8]). Use of high-dose GCs (≥10 mg/day of prednisone or equivalent) increased the rate of infection as compared with no GC use, after adjustment for MTX and TNF inhibitor use (HRadj 3.1 [95% CI 2.0, 4.7]).

Conclusion

Children with JIA had an increased rate of infection compared to children with ADHD. Among children with JIA, the rate of infection was not increased with MTX or TNF inhibitor use, but was significantly increased with high-dose GC use.

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