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http://hdl.handle.net/1843/46347| Type: | Artigo de Evento |
| Title: | Corticosteroid utilization and risk of infections among rheumatoid arthritis patients taking biologic and non-biologic disease modifying antirheumatic drugs |
| Authors: | Elham Rahme Hacene Nedjar Louis Bessette Francisco de Assis Acurcio |
| Abstract: | Background: Rheumatoid arthritis (RA) patients failing non-biologic disease modifying antirheumatic drugs (nbDMARDs) may undergo Tumor Necrosis Factor inhibitors (TNFi) therapy and/or use corticosteroid concomitantly. Objectives: Using Quebec health services administrative data, we examined corticosteroid use and rates of infection-related emergency department (ED) visits and/or hospitalizations among RA patients receiving TNFi, nbDMARDs, and a combination of TNFi and nbDMARDs with/without corticosteroids. Methods: We constructed an age (≥20 years), sex, calendar time (2002–2011) and high-dimensional propensity score matched RA cohort of TNFi versus nbDMARD users. Patients with infections in the prior three months were excluded. Patients were followed to the first date of death, infection occurrence or March 2012. Corticosteroid use at cohort entry was examined and time to interruption was assessed using COX models. Time-dependent Cox models were used to assess adjusted hazards ratios (HR) of infections for TNFi and nbDMARDs use with/without corticosteroid. Results: At cohort entry, 359 patients were in the TNFi, 544 in the TNFi + nbDMARDs, and 1,712 in the nbDMARD groups. Among these 37%, 39% and 34% were using corticosteroid, and 72%, 65% and 60% used corticosteroid in follow-up, respectively. Among corticosteroid users at cohort entry, TNFi users were 38% more likely to interrupt it during follow-up (HR 1.38; 95% confidence interval, CI 1.01, 1.90). Compared to time on nbDMARD (no corticosteroid), the HR of infections were as follows: TNFi 1.73 (1.18, 2.55), TNFi + nbDMARD 2.27 (1.62, 3.19), nbDMARDs + corticosteroid 3.13 (2.38, 4.14), TNFi + corticosteroid 5.69 (3.53, 9.16), TNFi + nbDMARDs + corticosteroid 3.84 (2.45, 6.03). Similar results were seen when we separately considered infection-related hospitalizations. Conclusions: RA patients using corticosteroid had high rates of infections whether they were on nbDMARDs or TNFi. The rates of infections were higher among users of TNFi with/without nbDMARDs compared to users nbDMARDs alone. |
| Subject: | Artrite reumatoide Doença autoimune Medicamentos |
| language: | eng |
| metadata.dc.publisher.country: | Brasil |
| Publisher: | Universidade Federal de Minas Gerais |
| Publisher Initials: | UFMG |
| metadata.dc.publisher.department: | FAR - DEPARTAMENTO DE FARMÁCIA SOCIAL |
| Rights: | Acesso Aberto |
| metadata.dc.identifier.doi: | https://doi.org/10.1002/pds.4275 |
| URI: | http://hdl.handle.net/1843/46347 |
| Issue Date: | 22-Aug-2017 |
| metadata.dc.url.externa: | https://onlinelibrary.wiley.com/doi/full/10.1002/pds.4275 |
| metadata.dc.relation.ispartof: | International Conference on Pharmacoepidemiology & Therapeutic Risk Management |
| Appears in Collections: | Artigo de Evento |
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