Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis
Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis
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DOI：
10.1093/rheumatology/kem076
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发表时间：
2007-07-01
期刊：
影响因子：
5.5
通讯作者：
Suissa, S.
中科院分区：
文献类型：
--
作者：
Bernatsky, S.;Hudson, M.;Suissa, S.
目标。评估与类风湿性关节炎 (RA) 中使用传统疾病缓解抗风湿药物 (DMARD) 和糖皮质激素药物相关的严重感染风险。方法。我们的研究是一项病例对照设计，纳入了 1980 年 1 月 1 日至 2003 年 12 月 31 日期间研究的 23733 名 RA 患者队列，匹配年龄和性别，并调整合并症和医生使用情况，使用条件逻辑回归来估计特定药物对需要住院感染的比率 (RR) 的影响。结果。当前暴露于环磷酰胺[RR：3.26，95％置信区间（CI）：2.28-4.67]和全身性糖皮质激素药物（RR：2.56，95％CI：2.29-2.85）时，所有需要住院治疗的感染的风险似乎最高；硫唑嘌呤与中度风险增加相关（RR：1.52，95% CI：1.18-1.97）。有人建议甲氨蝶呤会增加肺炎风险（RR：1. 16，95% CI：1.02-1.33）。引入抗肿瘤坏死因子（TNF）药物之前和之后的结果相似。抗 TNF 药物的 RR 点估计表明所有感染的风险增加约 2 倍，但该估计并不精确。结论。在这一大群 RA 患者中，使用糖皮质激素药物和免疫抑制 DMARD 导致严重感染的风险最高。与新兴疗法相关的感染风险评估应仔细考虑伴随的药物暴露，包括传统的 DMARD 和糖皮质激素治疗。
Objectives. To assess the risk of severe infections associated with the use of traditional disease-modifying anti-rheumatic drugs (DMARDs) and glucocorticoid agents in rheumatoid arthritis (RA).Methods. Our study was a case-control design nested within a cohort of 23733 RA patients studied between 1 January 1980 and 31 December 2003, Matching on age and gender, and adjusting for comorbidity and physician use, conditional logistic regression was used to estimate the effect of specific drugs on the rate ratio (RR) for infections requiring hospitalization.Results. The risk for all infections requiring hospitalization appeared to be most elevated with current exposures to cyclophosphamicle [RR: 3.26, 95% confidence interval (CI): 2.28-4.67] and systemic glucocorticoid agents (RR: 2.56, 95% CI: 2.29-2.85); azathioprine was associated with a moderate increased risk (RR: 1.52, 95% CI: 1.18-1.97). There was a suggestion of increased risk of pneumonia due to methotrexate (RR: 1. 16, 95% CI: 1.02-1.33). The results were similar for the period before and after the introduction of anti-tumour necrosis factor (TNF) agents. The RR point estimate for anti-TNF agents suggested about a 2-fold increased risk for all infections, but the estimate was imprecise.Conclusions. In this large cohort of RA patients, the most heightened risk of serious infections was seen with the use of glucocorticoid agents and immunosuppressive DMARDs. Assessments of infection risk related to newer and emerging therapies should carefully consider concomitant medication exposures, including traditional DMARDs and glucocorticoid therapy.