Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden
Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden
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DOI：
10.1002/art.21137
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发表时间：
2005-07-01
影响因子：
--
通讯作者：
Feltelius, N
中科院分区：
文献类型：
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作者：
Askling, J;Fored, CM;Feltelius, N
Objective.由于肿瘤坏死因子（TNF）拮抗剂治疗可能会增加结核病（TB）的风险，因为知识的风险，结核病在类风湿关节炎（RA）不与生物制剂治疗是稀缺的，不确定的普遍性，低风险人群，本研究旨在确定瑞典RA患者的风险。使用来自瑞典全国和基于人口的登记数据以及来自TNF拮抗剂的持续监测项目的数据，RA患者患结核病的相对风险（与一般人群相比）和与TNF拮抗剂相关的TB通过比较1999年至2001年3个RA队列和2个普通人群队列中因TB住院的发生率，确定了（与未接受生物制剂治疗的RA患者相比）。我们还回顾了瑞典所有接受TNF拮抗剂治疗的RA患者报告的结核病例的特征，并计算了1999年至2004年期间每种TNF拮抗剂的结核发病率。在1999-2001年期间，与普通人群相比，未接受TNF拮抗剂治疗的RA患者患TB的风险增加（相对风险2.0，95%置信区间[95% CI] 1.2-3.4）。与未接受TNF拮抗剂治疗的RA患者相比，接受TNF拮抗剂治疗的RA患者发生TB的风险增加4倍（相对风险4.0，95% CI 1.3-12）。1999-2004年期间，在暴露于TNF拮抗剂的RA患者中报告的TB病例（英夫利西单抗9例，依那西普4例，两者均2例）主要为肺结核。结核病发生在治疗开始后的3年内。无论是否给予TNF拮抗剂，瑞典RA患者患TB的风险增加。在1999-2001年期间，TNF拮抗剂与TB风险增加相关，幅度高达4倍。这种增加的风险可能在治疗期间持续存在，并且与英夫利西单抗和依那西普均相关。
Objective. Because treatment with tumor necrosis factor (TNF) antagonists may increase the risk of tuberculosis (TB), and because knowledge of the risk of TB in rheumatoid arthritis (RA) not treated with biologics is scarce and of uncertain generalizability to low-risk populations, this study sought to determine the risk of TB among Swedish patients with RA.Methods. Using data from Swedish nationwide and population-based registers and data from an ongoing monitoring program of TNF antagonists, the relative risks of TB in patients with RA (versus the general population) and of TB associated with TNF antagonists (versus RA patients not treated with biologics) were determined by comparing the incidence of hospitalization for TB in 3 RA cohorts and 2 general population cohorts from 1999 to 2001. We also reviewed the characteristics of all reported cases of TB in RA patients treated with TNF antagonists in Sweden and calculated the incidence of TB per type of TNF antagonist between 1999 and 2004.Results. During 1999-2001, RA patients who were not treated with TNF antagonists were at increased risk of TB versus the general population (relative risk 2.0, 95% confidence interval [95% CI] 1.2-3.4). RA patients treated with TNF antagonists had a 4-fold increased risk of TB (relative risk 4.0, 95% CI 1.3-12) versus RA patients not treated with TNF antagonists. The reported TB cases during 1999-2004 in RA patients exposed to TNF antagonists (9 infliximab, 4 etanercept, 2 both) were predominantly pulmonary. TB occurred up to 3 years following the start of treatment.Conclusion. Irrespective of whether TNF antagonists are administered, Swedish patients with RA are at increased risk of TB. During 1999-2001, TNF antagonists were associated with an increased risk of TB, up to 4-fold in magnitude. This increased risk may persist over time during treatment and is related to both infliximab and etanercept.