Risk of Hypersensitivity to Biologic Agents Among Medicare Patients With Rheumatoid Arthritis.
Risk of Hypersensitivity to Biologic Agents Among Medicare Patients With Rheumatoid Arthritis.
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DOI：
10.1002/acr.23141
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发表时间：
2017-10
影响因子：
4.7
通讯作者：
Curtis JR
中科院分区：
文献类型：
--
作者：
Yun H;Xie F;Beyl RN;Chen L;Lewis JD;Saag KG;Curtis JR
Hypersensitivity reactions (HSRs) can occur with any of the available biologic drugs used to treat rheumatoid arthritis (RA). We compared drug-specific risks for HSR among RA patients enrolled in the US Medicare program. Using Medicare data, we identified new users of infused infliximab, abatacept, rituximab, tocilizumab, golimumab, and injected biologics. After identifying HSRs using validated algorithms, for each biologic, we calculated cumulative incidence over 6 months and incidence rates (IR) within 0–1, 2–14 and 15–30 days of administration. For each biologic administration, follow-up started on the infusion/injection date and ended at the earliest of HSR, subsequent biologic administration, death, coverage loss, 30-day follow-up, or 12/31/2013. Adjusted robust Poisson regression was used to compare the HSR risks across biologics. Sensitivity analysis was conducted using a nested case-crossover design. We identified 725,591 biologic administrations and 248 HSRs among 80,587 new biologic users. Of these, 26.9% were for IV abatacept, 4.6% rituximab, 5.8% IV tocilizumab, 22.9% infliximab, and 39.7% injectable anti-TNFi. The cumulative incidence of HSRs over 6 months for all biologics was low (< 1%). The IRs for HSR ranged from 2.4 (with abatacept) to 239.5 (with rituximab) per 106 per person days. After adjustment, and using injectable anti-TNF during 0–30 days as the referent, rituximab, infliximab, abatacept, and tocilizumab infusions were associated a significant higher risk of HSR. Sensitivity analysis yielded similar results. Among RA patients taking biologics, rituximab and infliximab were most strongly associated with HSRs. The absolute IRs of HSR events for all biologic exposures were low.
