Giant cell arteritis treatment patterns and rates of serious infections.
Giant cell arteritis treatment patterns and rates of serious infections.
复制标题
DOI：
10.55563/clinexprheumatol/uonz1p
复制
发表时间：
2022-05
影响因子：
3.7
通讯作者：
Kim SC
中科院分区：
文献类型：
--
作者：
Tedeschi SK;Jin Y;Vine S;Lee H;Pethoe-Schramm A;Yau V;Kim SC
巨细胞动脉炎（GCA）折磨老年人，他们可能有年龄和合并症相关的感染风险，并使用增加感染风险的免疫抑制剂进行治疗。我们使用两个美国健康保险数据库Medicare（公共，2007-2017）和MarketScan（商业，2015-2019）确定了两个GCA队列，通过应用一种经验证的基于索赔的算法，GCA的阳性预测值为79.0%。我们要求年龄≥50岁，并评估基线合并症、免疫抑制剂和预防性抗生素的分发以及疫苗接种。我们计算了严重感染的发生率（IR），严重感染定义为基于主要住院诊断代码需要住院治疗的细菌或病毒感染。多变量考克斯比例风险模型估计了预先指定协变量的严重感染风险的风险比。医疗保险队列包括734名患者，28%为男性，平均年龄77.1岁; MarketScan队列包括1022名患者，30%为男性，平均年龄68.4岁。超过85%的患者在索引日期每天使用泼尼松≥ 60 mg，<10%的患者使用托珠单抗。27.9%的医疗保险患者和7.2%的MarketScan患者发生严重感染：医疗保险中每100人年的IR = 10.7（95% CI 9.3，12.2），MarketScan中为6.3（95% CI 5.0，7.9）。年龄较大和虚弱评分较高与严重感染的风险增加显著相关。在这两个美国GCA队列中，高剂量糖皮质激素是最常见的初始治疗，超过25%的医疗保险患者和7%的MarketScan患者在随访期间发生严重感染。年龄较大和虚弱评分较高与严重感染的风险较高相关，但最大每日泼尼松剂量与此无关。尽管很少使用预防性抗生素，但在两个GCA队列中，肺囊性Jiroveci肺炎是罕见的。
Giant cell arteritis (GCA) afflicts older adults who may have age- and comorbidity-related risks for infection and is treated with immunosuppressants that increase risk of infection. We examined GCA treatment patterns and rates of serious infections in two real-world cohorts in the U.S. We identified two GCA cohorts using two U.S. health insurance databases, Medicare (public, 2007–2017) and MarketScan (commercial, 2015–2019), by applying a validated claims-based algorithm with positive predictive value 79.0% for GCA. We required age ≥50 years and assessed baseline comorbidities, dispensing of immunosuppressants and prophylactic antibiotics, and vaccine administration. We calculated incidence rates (IR) of serious infections, defined as bacterial or viral infections requiring hospitalization based on primary inpatient diagnosis code. Multivariable Cox proportional hazards models estimated hazard ratios for risk of serious infection for prespecified covariates. The Medicare cohort included 734 patients, 28% male, mean age 77.1; the MarketScan cohort included 1022 patients, 30% male, mean age 68.4. More than 85% used prednisone ≥60mg daily at index date and <10% used tocilizumab. Serious infections developed in 27.9% of Medicare and 7.2% of MarketScan patients: IR per 100 person-years = 10.7 (95% CI 9.3, 12.2) in Medicare and 6.3 (95% CI 5.0, 7.9) in MarketScan. Older age and higher frailty score were significantly associated with increased risk for serious infection. In these two U.S. GCA cohorts, high-dose glucocorticoids were the most common initial treatment, and over 25% of Medicare and 7% of MarketScan patients developed serious infection during follow-up. Older age and higher frailty score were associated with higher risk of serious infections, though maximum daily prednisone dose was not. Pneumocystic jiroveci pneumonia was rare in two GCA cohorts despite infrequent use of prophylactic antibiotics.
登录
查看更多内容
影响因子：
3.4
作者：
Lee H;Tedeschi SK;Chen SK;Monach PA;Kim E;Liu J;Pethoe-Schramm A;Yau V;Kim SC
通讯作者：
Kim SC
影响因子：
158.5
作者：
Stone, J. H.;Tuckwell, K.;Collinson, N.
通讯作者：
Collinson, N.
影响因子：
4.7
作者：
Pappas, Dimitrios A.;Hooper, Michele M.;Curtis, Jeffrey R.
通讯作者：
Curtis, Jeffrey R.
影响因子：
4.7
作者：
Durand, Madeleine;Thomas, Sara L.
通讯作者：
Thomas, Sara L.
影响因子：
--
作者：
Wolfe, F;Caplan, L;Michaud, K
通讯作者：
Michaud, K