RESEARCH - Association of MTX, TNF antagonists, and prednisone with risk of infection: CORRONA

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Ann Rheum Dis. 2009 Apr 8.

Association of Methotrexate and TNF antagonists with risk of infection

outcomes including opportunistic infections in the CORRONA registry.

Greenberg JD, G, Kremer JM, Tindall E, Kavanaugh A, Zheng C,

Bishai W, Hochberg M.

NYU Hospital for Joint Diseases, United States.

OBJECTIVE: To examine the association of methotrexate (MTX) and TNF

antagonists with risk of infectious outcomes including opportunistic

infections in patients with rheumatoid arthritis (RA).

METHODS: RA patients enrolled in the Consortium of Rheumatology

Researchers of North America (CORRONA) registry prescribed MTX, TNF

antagonists or other disease modifying anti-rheumatic drugs (DMARDs)

were included. The primary outcomes were incident overall and

opportunistic infections. Incident rate ratios were calculated using

Generalized Estimating Equation (GEE) Poisson regression models

adjusted for demographics, comorbidities and RA disease activity

measures.

RESULTS: A total of 7,971 RA patients were followed. Adjusted rate of

infections per 100 person-years was increased among MTX (30.9, 95% CI

[29.2, 32.7]), TNF antagonist (40.1, 95% CI [37.0, 43.4]) and

combination MTX/TNF antagonist users (37.1, 95% CI [34.9, 39.3])

versus other nonbiologic DMARD users (24.5, 95% CI [21.8, 27.5]). The

adjusted incidence rate ratio (IRR) was increased for patients

prescribed MTX (IRR 1.30, 95% CI 1.12-1.50) and TNF antagonists (IRR

1.52, 95% CI 1.30-1.78) compared to other DMARD users. For

opportunistic infections, TNF antagonist use (IRR 1.67, 95% CI

0.95-2.94) was associated with increased risk. Prednisone use was

associated with an increased risk of opportunistic infection (IRR

1.63, 95% CI 1.20-2.21) and an increased risk of overall infection at

doses > 10 mg daily (IRR 1.30, 95% CI 1.11-1.53).

CONCLUSIONS: MTX, TNF antagonists and prednisone at doses >10 mg daily

were associated with increased risks of overall infections. Low-dose

prednisone and TNF antagonists, but not MTX, increased risk for

opportunistic infections.

PMID: 19359261

http://www.ncbi.nlm.nih.gov/pubmed/19359261

Not an MD