RESEARCH - Rates of serious infection in RA patients receiving anti-TNF therapy

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Arthritis Rheum. 2006 Jul 25;54(8):2368-2376 [Epub ahead of print]

Rates of serious infection, including site-specific and bacterial

intracellular infection, in rheumatoid arthritis patients receiving

anti-tumor necrosis factor therapy: Results from the British Society for

Rheumatology Biologics Register.

Dixon WG, K, Lunt M, Hyrich KL, Silman AJ, Symmons DP.

British Society for Rheumatology Biologics Register Control Centre

Consortium.

OBJECTIVE: To determine whether the rate of serious infection is higher in

anti-tumor necrosis factor (anti-TNF)-treated rheumatoid arthritis (RA)

patients compared with RA patients treated with traditional

disease-modifying antirheumatic drugs (DMARDs). METHODS: This was a national

prospective observational study of 7,664 anti-TNF-treated and 1,354

DMARD-treated patients with severe RA from the British Society for

Rheumatology Biologics Register. All serious infections, stratified by site

and organism, were included in the analysis. RESULTS: Between December 2001

and September 2005, there were 525 serious infections in the

anti-TNF-treated cohort and 56 in the comparison cohort (9,868 and 1,352

person-years of followup, respectively). The incidence rate ratio (IRR),

adjusted for baseline risk, for the anti-TNF-treated cohort compared with

the comparison cohort was 1.03 (95% confidence interval 0.68-1.57). However,

the frequency of serious skin and soft tissue infections was increased in

anti-TNF-treated patients, with an adjusted IRR of 4.28 (95% confidence

interval 1.06-17.17). There was no difference in infection risk between the

3 main anti-TNF drugs. Nineteen serious bacterial intracellular infections

occurred, exclusively in patients in the anti-TNF-treated cohort.

CONCLUSION: In patients with active RA, anti-TNF therapy was not associated

with increased risk of overall serious infection compared with DMARD

treatment, after adjustment for baseline risk. In contrast, the rate of

serious skin and soft tissue infections was increased, suggesting an

important physiologic role of TNF in host defense in the skin and soft

tissues beyond that in other tissues.

PMID: 16868999

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6868999

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