Overall infection risk in rheumatoid arthritis during treatment with abatacept, rituximab and tocilizumab; an observational cohort study
Overall infection risk in rheumatoid arthritis during treatment with abatacept, rituximab and tocilizumab; an observational cohort study
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DOI：
10.1093/rheumatology/kez530
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发表时间：
2020-08-01
期刊：
影响因子：
5.5
通讯作者：
Hetland, Merete L.
中科院分区：
文献类型：
--
作者：
Gron, Kathrine L.;Glintborg, Bente;Hetland, Merete L.
目的：大多数类风湿性关节炎患者的感染在初级保健中使用抗生素治疗。一小部分需要住院治疗。只有少数研究存在于开始非tnf抑制剂治疗的患者感染的总体风险（即抗生素处方或因感染住院）。在丹麦，在常规护理中开始阿巴接受、利妥昔单抗和托珠单抗治疗的RA患者，目的是比较感染的调整发生率（IR），并估计0-12个月和0-24个月期间药物感染的相对风险。方法：这是一项观察性队列研究，包括DANBIO注册的所有RA患者，从2010年到2017年开始使用非tnf抑制剂。感染被定义为抗生素处方或因感染住院。通过与国家登记处的联系，收集了处方、合并症和感染情况。计算感染的IRs（年龄、性别调整后）和比率（作为RR（相对风险）的估计值），并根据其他协变量进行调整（泊松回归）。结果：我们确定了3696次治疗（阿巴接受1115，利妥昔单抗1017，托珠单抗1564）。在基线时，利妥昔单抗使用者年龄较大，既往癌症患者较多。在0-12个月内，发生了1747例感染。年龄和性别调整后的每100人年ir如下：接受值：76 (95% CI: 69,84)；利妥昔单抗：87 (95% CI: 79,96)；托珠单抗：77 （95% CI: 71,84）。阿巴接受与利妥昔单抗的调整后相对危险度分别为0.94 （95% CI: 0.81, 1.08）和0.94 (95% CI: 0.81, 1.03)，阿巴接受与托珠单抗的调整后相对危险度分别为1.00 （95% CI: 0.88, 1.14）。24个月后观察到rr约为1。戒烟者和曾经吸烟的人分别比不吸烟的人和从不吸烟的人有更高的风险。结论：总体感染在非tnf抑制剂治疗的RA患者中很常见，倾向于使用利妥昔单抗的风险最高，但在所有分析中ci都很广泛。由指示引起的混淆至少可以部分解释任何差异。
Objectives: Most infections in patients with RA are treated in primary care with antibiotics. A small fraction require hospitalization. Only a few studies exist regarding the overall risk of infection (i.e. prescription of antibiotics or hospitalization due to infection) in patients initiating non-TNF-inhibitor therapy. In Danish RA patients initiating abatacept, rituximab and tocilizumab treatment in routine care, the aims were to compare adjusted incidence rates (IR) of infections and to estimate relative risk of infections across the drugs during 0-12 and 0-24 months.Methods: This was an observational cohort study including all RA patients in the DANBIO registry starting a non-TNF-inhibitor from 2010 to 2017. Infections were defined as a prescription of antibiotics or hospitalization due to infection. Prescriptions, comorbidities and infections were captured through linkage to national registries. IRs of infections (age, gender adjusted) and rate ratios (as estimates of RR (relative risk)), adjusted for additional covariates) (Poisson regression) were calculated.Results: We identified 3696 treatment episodes (abatacept 1115, rituximab 1017, tocilizumab 1564). At baseline, rituximab users were older and had more previous cancer. During 0-12 months, 1747 infections occurred. Age and gender-adjusted IRs per 100 person-years were as follows: abatacept: 76 (95% CI: 69, 84); rituximab: 87 (95% CI: 79, 96); tocilizumab: 77 (95% CI: 71, 84). Adjusted RRs were 0.94 (95% CI: 0.81, 1.08) for abatacept and 0.94 (95% CI: 0.81, 1.03) for tocilizumab compared with rituximab and 1.00 (95% CI: 0.88, 1.14) for abatacept compared with tocilizumab. RRs around 1 were observed after 24 months. Switchers and ever smokers had higher risk compared with biologic-naive and never smokers, respectively.Conclusion: Overall infections were common in non-TNF-inhibitor-treated RA patients, with a tendency towards rituximab having the highest risk, but CIs were wide in all analyses. Confounding by indication may at least partly explain any differences.