Risk of tuberculosis, serious infection and lymphoma with disease-modifying biologic drugs in rheumatoid arthritis patients in Taiwan

被引:29
作者
Chiu, Ying-Ming [1 ,2 ]
Lang, Hui-Chu [3 ]
Lin, Hsiao-Yi [4 ]
Yang, Ming-Ta [5 ,6 ]
Fang, Chi-Hui [7 ,8 ]
Yang, Ya-Wen [7 ,8 ]
Schabert, Vernon F. [9 ]
Tang, Boxiong [7 ,8 ]
机构
[1] Changhua Christian Hosp, Div Allergy Immunol & Rheumatol, Changhua, Taiwan
[2] HungKuang Univ, Coll Med & Nursing, Dept Nursing, Taichung, Taiwan
[3] Natl Yang Ming Univ, Inst Hosp & Hlth Care Adm, Taipei 112, Taiwan
[4] Vet Gen Hosp, Dept Med, Div Allergy Immunol & Rheumatol, Taipei, Taiwan
[5] IMS Hlth, Taipei, Taiwan
[6] IMS Hlth, New York, NY USA
[7] Pfizer Inc, Taipei, Taiwan
[8] Pfizer Inc, New York, NY USA
[9] IMS Hlth, Woodland Hills, CA USA
关键词
epidemiology; health services and health care economics; rheumatoid arthritis; NECROSIS-FACTOR ANTAGONISTS; FACTOR MONOCLONAL-ANTIBODY; BRITISH-SOCIETY; FACTOR THERAPY; TNF THERAPY; METHOTREXATE; INFLIXIMAB; RECOMMENDATIONS; ASSOCIATION; REGISTER;
D O I
10.1111/1756-185X.12539
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
AimTo determine the risk of adverse events in rheumatoid arthritis (RA) patients treated with biological disease-modifying anti-rheumatic drugs (bDMARD) versus traditional DMARDs (tDMARD). MethodThis retrospective study used Taiwan's National Health Insurance Research Database to capture data for adult patients diagnosed with RA between 1 January 1999 and 31 December 2009 and treated with tDMARD or bDMARD. The endpoints were patients with cases of an inpatient serious bacterial infection (SBI), diagnosis of tuberculosis (TB) or lymphoma. Within the bDMARD cohort, individual bDMARDS with adequate data were also compared (adalimumab and etanercept). Propensity-score matching was used to adjust for significant (P0.05) patient characteristics. Incidence rate ratios (IRR) of SBI/TB/lymphoma cases versus non-cases were adjusted for exposure time (rate per 100000 patient-years) and 95% confidence intervals were constructed to assess whether IRRs differed from 1.0. ResultsOf 34947 potential patients, 7888 tDMARD, 3459 bDMARD (including 1492 etanercept and 746 adalimumab) patients were matched for analysis. A total of 2150 cases were identified and of these 1711 were SBI, 406 as TB and 33 as lymphoma. For all cases except SBI, the IRR (95% CI) was higher for bDMARD versus tDMARD (SBI 1.04 [0.89-1.19]; TB 2.67 [2.12-3.34]; lymphoma 3.24 [1.37-7.06]). Excepting lymphoma, IRR was higher for adalimumab versus etanercept (SBI 1.83 [1.19-2.77]; TB 2.35 [1.29-4.15]; lymphoma 1.49 [0.03-18.66]). ConclusionsThere was a higher risk for specified infections and lymphoma with bDMARD versus tDMARD and adalimumab versus etanercept.
引用
收藏
页码:9 / 19
页数:11
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