Journal
ARTHRITIS CARE & RESEARCH
Volume 66, Issue 7, Pages 990-997Publisher
WILEY-BLACKWELL
DOI: 10.1002/acr.22281
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Funding
- Agency for Healthcare Research and Quality [R01-HS-018517, 1U18-HS-016956, R01-HS018517, U18-HS016956]
- Anolinx
- Genentech
- NIH [AR-053351]
- NIH/National Institute for Arthritis and Musculoskeletal and Skin Diseases [K24-AR052361]
- Pfizer
- BMS
- Crescendo
- UCB
- AbbVie
- Roche/Genentech
- Janssen
- CORRONA
- Amgen
- Savient
- Regeneron
- URL Pharmaceuticals
- Ardea
- Allergan
- Novartis
- Takeda
- Roche
- Abbott
- Merck
- Mylan Specialty
- Shire
- Hoffman-La Roche
- Dey Pharma
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Objective. The comparative risk of infection associated with non-anti-tumor necrosis factor (anti-TNF) biologic agents is not well established. Our objective was to compare risk for hospitalized infections between anti-TNF and non-anti-TNF biologic agents in US veterans with rheumatoid arthritis (RA). Methods. Using 1998-2011 data from the US Veterans Health Administration, we studied RA patients initiating rituximab, abatacept, or anti-TNF therapy. Exposure was based upon days supplied (injections) or usual dosing intervals (infusions). Treatment episodes were defined as new biologic agent use. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for hospitalization for a bacterial infection were estimated from Cox proportional hazards models, adjusting for potential confounders. Results. Among 3,152 unique RA patients contributing 4,158 biologic treatment episodes to rituximab (n = 596), abatacept (n = 451), and anti-TNF agents (n = 3,111), the patient mean age was 60 years and 87% were male. The most common infections were pneumonia (37%), skin/soft tissue (22%), urinary tract (9%), and bacteremia/sepsis (7%). Hospitalized infection rates per 100 person-years were 4.4 (95% CI 3.1-6.4) for rituximab, 2.8 (95% CI 1.7-4.7) for abatacept, and 3.0 (95% CI 2.5-3.5) for anti-TNF. Compared to etanercept, the adjusted rate of hospitalized infection was not different for adalimumab (HR 1.4, 95% CI 0.9-2.2), abatacept (HR 1.1, 95% CI 0.6-2.1), or rituximab (HR 1.4, 0.8-2.6), although it was increased for infliximab (HR 2.3, 95% CI 1.3-4.0). Infection risk was greater for those taking prednisone >7.5 mg/day (HR 1.8, 95% CI 1.3-2.7) and in the highest quartile of C-reactive protein (HR 2.3, 95% CI 1.4-3.8) and erythrocyte sedimentation rate (HR 4.1, 95% CI 2.3-7.2) compared to the lowest quartile. Conclusion. In older, predominantly male US veterans with RA, the risk of hospitalized bacterial infections associated with rituximab or abatacept was similar to etanercept.
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