Rheumatology Advance Access originally published online on May 3, 2007
Rheumatology 2007 46(7):1157-1160; doi:10.1093/rheumatology/kem076
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Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis
1Division of Clinical Epidemiology, McGill University Health Centre and 2Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
Correspondence to: Dr S. Bernatsky, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V-Building, Montreal, Quebec H3A 1A1, Canada. E-mail: sasha.bernatsky{at}mail.mcgill.ca
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Abstract |
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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 23 733 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 cyclophosphamide [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.
KEY WORDS: Rheumatoid arthritis, Disease-modifying anti-rheumatic drugs, DMARDs, Infections, Pneumonia, glucocorticoid agents
Submitted 26 October 2006;
revised version accepted 2 March 2007.
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