Risk of infections in rheumatoid arthritis patients treated with tocilizumab
Risk of infections in rheumatoid arthritis patients treated with tocilizumab
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DOI：
10.1093/rheumatology/ker223
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发表时间：
2012-05-01
期刊：
影响因子：
5.5
通讯作者：
Zwerina, Jochen
中科院分区：
文献类型：
--
作者：
Lang, Veronika R.;Englbrecht, Matthias;Zwerina, Jochen
目标.目的探讨托西珠单抗治疗类风湿关节炎（RA）患者感染的发生率及其危险因素。对2008年10月至2010年3月期间在北方巴伐利亚开始托珠单抗治疗的所有RA患者（n = 112）进行感染筛查。记录轻度/中度和重度感染。采用多因素Logistic回归分析确定感染的危险因素。总体而言，26例患者发生感染[23.2%; 58.0/100患者-年（py）]，其中18例为轻度至中度（16.1%，40.1/100 py），8例为重度（17.9/100 py）。同时使用LEF和泼尼松、高疾病活动度和既往利妥昔单抗治疗与轻度/中度感染的发生相关。严重感染与病程较长、既往使用过3种以上DMARDs和质子泵辅助治疗有关。临床实践中接受托珠单抗治疗的RA患者的感染率高于临床试验人群。应特别关注病程较长、既往暴露于多种DMARD（即既往暴露于利妥昔单抗）和接受LEF、泼尼松或质子泵抑制剂伴随治疗的患者。
Objectives. To investigate the occurrence and risk factors for infections in RA patients treated with tocilizumab.Methods. A cohort of all RA patients (n = 112) starting tocilizumab therapy between October 2008 and March 2010 in Northern Bavaria was screened for infections. Mild/moderate and severe infections were recorded. Multivariate logistic regression analysis was used to define risk factors for infection.Results. Overall, 26 patients developed infections [23.2%; 58.0/100 patient-years (py)], 18 of them were mild to moderate (16.1%, 40.1/100 py) and 8 were severe (17.9/100 py). Concomitant use of LEF and prednisone, high disease activity and previous therapy with rituximab were associated with the occurrence of mild/moderate infections. Severe infections were related to longer disease duration, exposure to more than three previous DMARDs and concomitant therapy with proton-pump inhibitors.Conclusion. The rate of infection in RA patients treated with tocilizumab in clinical practice is higher than in the clinical trial populations. Increased attention should especially be given to patients with longer disease duration, previous exposure to multiple DMARDs, i.e. previous exposure to rituximab and those receiving concomitant LEF, prednisone or proton-pump inhibitor treatment.