RESEARCH - Association of MTX and TNF antagonists with risk of infection outcome including opportunistic infections: CORRONA

[Guest guest]

Ann Rheum Dis. Published Online First: 8 April 2009.

doi:10.1136/ard.2008.089276

--------------------------------------------------------------------------------

Extended Report

Association of Methotrexate and TNF antagonists with risk of infection

outcomes including opportunistic infections in the CORRONA registry

J D Greenberg 1*, G 2, J M Kremer 3, E Tindall 4, A Kavanaugh 5,

C Zheng 4, W Bishai 6 and M Hochberg 7

1 NYU Hospital for Joint Diseases, United States

2 University of Massachusetts Medical School, United States

3 The Center for Rheumatology, United States

4 Genentech, Inc., United States

5 University of California at San Diego, United States

6 s Hopkins University, United States

7 University of land on behalf of the CORRONA Investigators, United States

Abstract

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.

http://ard.bmj.com/cgi/content/abstract/ard.2008.089276v1?papetoc

Not an MD