PMID- 30148440
OWN - NLM
STAT- Publisher
LR  - 20180827
IS  - 0392-856X (Print)
IS  - 0392-856X (Linking)
DP  - 2018 Jul 18
TI  - Risk of hospitalisation for serious bacterial infections in patients with
      rheumatoid arthritis treated with biologics. Analysis from the RECord linkage On 
      Rheumatic Disease study of the Italian Society for Rheumatology.
AB  - OBJECTIVES: The aims of this study were to define the risk of serious bacterial
      infections in patients receiving specific biological disease-modifying
      anti-rheumatic drugs (bDMARDs) and evaluating the effect of concomitant synthetic
      DMARDs (sDMARDs) in a large population-based sample of rheumatoid arthritis (RA) 
      deriving from an administrative health database. METHODS: Data were extracted
      from health databases of Lombardy Region, Italy (2004-2013), as a part of the
      RECord-linkage On Rheumatic Diseases (RECORD) study. Patients with RA treated
      with approved bDMARDs were included. Hospitalisations for bacterial infections
      were evaluated by hospital discharge forms. The association between drug exposure
      and infections was assessed by survival models, with time-dependent covariates.
      Results are presented as hazard ratios (HR) and 95%CI, crude and adjusted for
      pre-specified confounders (sex, age, disease duration, Charlson Comorbidity
      Index, previous biologics, previous infections, use of methotrexate, leflunomide,
      corticosteroids, non-steroidal anti-inflammatory drugs). RESULTS: 4,656 RA
      patients with at least one bDMARD prescription were included, for a total of
      7,601 biological courses; 3,603 (77.4%) women with a mean (SD) age of 55.8 (12.7)
      years. Crude incidence rate of hospitalised infection ranged from 0.14 to 2.95
      per 1000 person-years. After multivariable adjustment, abatacept users (HR 0.29, 
      95%CI 0.10-0.82) had significantly lower risk of infections compared to
      etanercept. Concurrent treatment with methotrexate (0.72, 0.52-0.99) reduced the 
      overall risk of infection while glucocorticoids increased it (1.09 per mg/day,
      1.06-1.11). CONCLUSIONS: In RA patients treated with bDMARDs, abatacept was
      associated with the lowest risk of infections; overall risk was mitigated by
      concomitant methotrexate and increased by glucocorticoids in a dose-dependent
      manner.
FAU - Carrara, Greta
AU  - Carrara G
AD  - Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy.
FAU - Bortoluzzi, Alessandra
AU  - Bortoluzzi A
AD  - Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Italy.
FAU - Sakellariou, Garifallia
AU  - Sakellariou G
AD  - Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation,
      University of Pavia, Italy.
FAU - Silvagni, Ettore
AU  - Silvagni E
AD  - Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Italy.
FAU - Zanetti, Anna
AU  - Zanetti A
AD  - Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy.
FAU - Govoni, Marcello
AU  - Govoni M
AD  - Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Italy.
FAU - Scire, Carlo Alberto
AU  - Scire CA
AD  - Epidemiology Research Unit, Italian Society for Rheumatology, Milan; and
      Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Italy. 
      c.scire@reumatologia.it.
LA  - eng
PT  - Journal Article
DEP - 20180718
PL  - Italy
TA  - Clin Exp Rheumatol
JT  - Clinical and experimental rheumatology
JID - 8308521
EDAT- 2018/08/28 06:00
MHDA- 2018/08/28 06:00
CRDT- 2018/08/28 06:00
PHST- 2018/01/18 00:00 [received]
PHST- 2018/04/11 00:00 [accepted]
PHST- 2018/08/28 06:00 [entrez]
PHST- 2018/08/28 06:00 [pubmed]
PHST- 2018/08/28 06:00 [medline]
AID - 12628 [pii]
PST - aheadofprint
SO  - Clin Exp Rheumatol. 2018 Jul 18. pii: 12628.