Table 39Infection in patients with rheumatoid arthritis treated with corticosteroids

StudyStudy Design
Study PopulationDrugResultsQuality Rating
*Bernatsky et al., 2007218Nested case-control
Up to 23 years
RA pts registered in claims databases in QuebecGlucocorticoidsThe risk for all infections requiring hospitalization was most elevated with glucocorticoid agents (RR, 2.6; 95% CI, 2.3 to 2.9); Similar effects were seen with pneumonia as the outcome (RR, 2.1; 95% CI, 2.4 to 3.1).Fair
*Brassard et al., 2006219Retrospective cohort study
Up to 5 years
RA pts from PharMetrics data (U.S.)Several oral DMARDs, biologic DMARDs, corticosteroidsAdjusted rate ratio of developing TB with corticosteroids: 1.7 (95% CI, 1.3 to 2.2).Fair
Doran et al., 2002220Retrospective cohort
39 years
RA patientsSeveral oral DMARDs, corticosteroidsIn patients hospitalized for infection, corticosteroid use increased risk (HR, 1.56; 95% CI, 1.20 to 2.04)Fair
*Lacaille et al., 2008221Retrospective cohort
162,720 person years
Pts with RA from British Columbia, CanadaOral DMARDs, corticosteroidsAdjusted Rate Ratio for serious infections:
DMARDs+corticosteroids: 1.63 (95% CI, 1.5 to 1.77); corticosteroids alone: 1.9 (95% CI, 1.75 to 2.05)
*Greenberg et al., 2010226
Prospective cohort
15,047 person-years
Pts with RA enrolled in the Consortium of Rheumatology Researchers of North America (CORRONA) registryMTX, oral DMARDs, anti-TNF agents, PREDAdjusted incidence rate ratio of infection and opportunistic infection for PRED compared with oral DMARDs, respectively: IRR 1.05 (0.97–1.15, P=0.251); IRR 1.63 (1.20–2.21, P=0.002)
PRED above 10 mg daily associated with risk of infection (IRR 1.30, 95% 1.11–1.53, P=0.001)
*Schneeweiss et al., 2007222Retrospective cohort
Up to 8 years
Medicare beneficiaries ages 65 and older with RAGlucocorticoidsCompared with MTX use, glucocorticoid use associated with serious bacterial infections (RR, 2.25; 95% CI, 1.57 to 3.22)Fair
*Smitten et al., 2008223Retrospective cohort
26.6 months
RA pts from PharMetrics data (U.S.)CorticosteroidsOral corticosteroid use increased risk of hospitalized infection (RR, 1.92; 95% CI, 1.67 to 2.21). Risk increased with dose.Good
*Smitten et al., 2007224Retrospective cohort
12,272 (PM)38,621 (GPRD)
12.3 to 38.8 months
RA pts from PM database and UK GPRDCorticosteroidsRisk of herpes zoster infection with corticosteroids only:
(PM: OR, 2.51; 95% CI, 2.05 to 3.06
GPRD: 1.46; 95% CI, 1.24 to 1.70)
*Strangfeld et al., 2009225Prospective cohort
up to 36 months
RA pts initiating biologic therapy or switching to another DMARDGlucocorticoidsAdjusted HR for herpes zoster.
Glucocorticoids 1 mg to 9 mg (HR, 1.86; 95% CI, 0.92 to 3.78); Glucocorticoids 10+mg (HR, 2.52; 95% CI, 1.12 to 5.65)

New study added since last review.

AE = adverse event; BUD = budesonide; CI = confidence interval; DMARD = disease-modifying antirheumatic drugs; GI = gastrointestinal; GPRD = General Practice Research Database; mg = milligram; HR = hazard ratio; MTX = methotrexate; OR = odds ratio; PM = Pharmetrics; PNL = prednisolone; PRED = prednisone; RA = rheumatoid arthritis; RCT = randomized controlled trial; RR = relative risk; TB = tuberculosis

From: Results

Cover of Drug Therapy for Rheumatoid Arthritis in Adults: An Update
Drug Therapy for Rheumatoid Arthritis in Adults: An Update [Internet].
Comparative Effectiveness Reviews, No. 55.
Donahue KE, Jonas DE, Hansen RA, et al.

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