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Risk of serious inf...
Risk of serious infections in patients with rheumatoid arthritis treated in routine care with abatacept, rituximab and tocilizumab in Denmark and Sweden
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- Gron, KL (author)
- Karolinska Institutet,Rigshosp, Denmark; Rigshosp, Denmark; Univ Copenhagen, Denmark,Karolinska Inst, Sweden
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- Arkema, EV (author)
- Karolinska Institutet,Karolinska Inst, Dept Med, Stockholm, Sweden
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- Glintborg, B (author)
- Rigshosp, DANBIO, Copenhagen, Denmark;Rigshosp, Ctr Head & Orthoped, Ctr Rheumatol & Spine Dis, Copenhagen Ctr Arthrit Res COPECARE, Copenhagen, Denmark;Copenhagen Univ Hosp, Gentofte & Herlev Hosp, Dept Rheumatol, Copenhagen, Denmark
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- Mehnert, F (author)
- Aarhus Univ Hosp, Dept Clin Epidemiol, Aarhus, Denmark
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- Ostergaard, M (author)
- Rigshosp, DANBIO, Copenhagen, Denmark;Rigshosp, Ctr Head & Orthoped, Ctr Rheumatol & Spine Dis, Copenhagen Ctr Arthrit Res COPECARE, Copenhagen, Denmark;Univ Copenhagen, Fac Hlth & Med Sci, Dept Clin Med, Copenhagen, Denmark
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- Dreyer, L (author)
- Aalborg Univ, Dept Clin Med, Aalborg, Denmark;Aalborg Univ, Dept Rheumatol, Aalborg, Denmark;Aalborg Univ Hosp, Aalborg, Denmark
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- Norgaard, M (author)
- Aarhus Univ Hosp, Dept Clin Epidemiol, Aarhus, Denmark
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- Krogh, NS (author)
- ZiteLab ApS, Copenhagen, Denmark
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- Askling, J (author)
- Karolinska Institutet,Karolinska Inst, Dept Med, Stockholm, Sweden;Karolinska Inst, Stockholm, Sweden
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- Hetland, ML (author)
- Rigshosp, DANBIO, Copenhagen, Denmark;Rigshosp, Ctr Head & Orthoped, Ctr Rheumatol & Spine Dis, Copenhagen Ctr Arthrit Res COPECARE, Copenhagen, Denmark;Univ Copenhagen, Fac Hlth & Med Sci, Dept Clin Med, Copenhagen, Denmark
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- Askling, J (author)
- Karolinska Institutet
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- Klareskog, L (author)
- Karolinska Institutet
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- Feltelius, N (author)
- Karolinska Inst, Sweden
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- Baecklund, Eva, 1956- (author)
- Uppsala universitet,Reumatologi,Uppsala Univ, Sweden
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- Sjöwall, Christopher (author)
- Linköpings universitet,Avdelningen för neuro- och inflammationsvetenskap,Medicinska fakulteten,Region Östergötland, Reumatologiska kliniken i Östergötland
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- Rantapaa-Dahlqvist, S (author)
- Umea Univ, Sweden
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- Forsblad-d'Elia, H (author)
- Umea Univ, Sweden
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- Jacobsson, L (author)
- Sahlgrens Acad, Sweden
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- Turesson, C (author)
- Lund Univ, Sweden
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- Lindqvist, E (author)
- Lund Univ, Sweden
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- Nisell, R (author)
- Swedish Rheumatol Qual Register, Sweden
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(creator_code:org_t)
- 2019-01-05
- 2019
- English.
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In: Annals of the rheumatic diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 78:3, s. 320-327
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Abstract
Subject headings
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- To estimate (1) crude and age-and gender-adjusted incidence rates (IRs) of serious infections (SI) and (2) relative risks (RR) of SI in patients with rheumatoid arthritis (RA) initiating treatment with abatacept, rituximab or tocilizumab in routine care.MethodsThis is an observational cohort study conducted in parallel in Denmark and Sweden including patients with RA in Denmark (DANBIO) and Sweden (Anti-Rheumatic Treatment in Sweden Register/Swedish Rheumatology Quality Register) who started abatacept/rituximab/tocilizumab in 2010–2015. Patients could contribute to more than one treatment course. Incident SI (hospitalisations listing infection) and potential confounders were identified through linkage to national registries. Age- and gender-adjusted IRs of SI per 100 person years and additionally adjusted RRs of SI during 0–12 and 0–24 months since start of treatment were assessed (Poisson regression). Country-specific RRs were pooled using inverse variance weighting.ResultsWe identified 8987 treatment courses (abatacept: 2725; rituximab: 3363; tocilizumab: 2899). At treatment start, rituximab-treated patients were older, had longer disease duration and more previous malignancies; tocilizumab-treated patients had higher C reactive protein. During 0–12 and 0–24 months of follow-up, 456 and 639 SI events were identified, respectively. The following were the age- and gender-adjusted 12-month IRs for abatacept/rituximab/tocilizumab: 7.1/8.1/6.1 for Denmark and 6.0/6.4/4.7 for Sweden. The 24-month IRs were 6.1/7.5/5.2 for Denmark and 5.6/5.8/4.3 for Sweden. Adjusted 12-month RRs for tocilizumab versus rituximab were 0.82 (0.50 to 1.36) for Denmark and 0.76 (0.57 to 1.02) for Sweden, pooled 0.78 (0.61 to 1.01); for abatacept versus rituximab 0.94 (0.55 to 1.60) for Denmark and 0.86 (0.66 to 1.13) for Sweden, pooled 0.88 (0.69 to 1.12); and for abatacept versus tocilizumab 1.15 (0.69 to 1.90) for Denmark and 1.14 (0.83 to 1.55) for Sweden, pooled 1.13 (0.91 to 1.42). The adjusted RRs for 0–24 months were similar.ConclusionFor patients starting abatacept, rituximab or tocilizumab, differences in baseline characteristics were seen. Numerical differences in IR of SI between drugs were observed. RRs seemed to vary with drug (tocilizumab < abatacept < rituximab) but should be interpreted with caution due to few events and risk of residual confounding.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reumatologi och inflammation (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Rheumatology and Autoimmunity (hsv//eng)
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Gron, KL
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Arkema, EV
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Glintborg, B
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Mehnert, F
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Ostergaard, M
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Dreyer, L
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Norgaard, M
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Krogh, NS
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Askling, J
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Hetland, ML
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Klareskog, L
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Feltelius, N
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Baecklund, Eva, ...
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Sjöwall, Christo ...
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Rantapaa-Dahlqvi ...
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Forsblad-d'Elia, ...
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Jacobsson, L
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Turesson, C
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Lindqvist, E
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Nisell, R
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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Annals of the rh ...
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Karolinska Institutet
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Uppsala University
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Linköping University