Corticosteroid utilization and risk of infections among rheumatoid arthritis patients taking biologic and non-biologic disease modifying antirheumatic drugs
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Universidade Federal de Minas Gerais
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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.
Abstract
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Artrite reumatoide, Doença autoimune, Medicamentos
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Artrite reumatoide, Doença autoimune, Medicamentos
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https://onlinelibrary.wiley.com/doi/full/10.1002/pds.4275