OBJECTIVE: This study compared the incidence and hazard of ICD-9-CM-coded infections and severe infections in rheumatoid arthritis (RA) patients treated with subsequent-line (SL) BIOs (BIO) after switching from first-line (FL) anti-TNF therapy (anti-TNF). METHODS: Retrospective analysis of a large U.S. claims database. RA patients initiating an FL anti-TNF between 1/1/2004 and 3/31/2010 were identified and followed forward in time to capture all SL BIO episodes through 3/31/2010. SL BIO episodes were classified into: abatacept, adalimumab, etanercept, infliximab, or rituximab. Multivariate mixed-effects survival models compared the hazard of infections and severe infections across the SL BIO episodes with adjustment for demographic and clinical confounders. RESULTS: In total, 4332 SL BIO episodes were identified: mean age 55 years; 80% female. In adjusted analyses: when compared to rituximab, the hazard of all infections was significantly higher for adalimumab (hazard ratio [HR] = 1.31, 95% confidence interval [CI] = 1.09-1.55), etanercept (HR = 1.44, 95% CI = 1.20-1.72), and infliximab (HR = 1.30, 95% CI = 1.07-1.57), and insignificantly different for abatacept (HR = 1.18, 95% CI = 0.98-1.41); when compared to rituximab, the hazard of severe infection was significantly higher for infliximab (HR = 1.62, 95% CI = 1.03-2.55), and insignificantly different for abatacept (HR = 1.21, 95% CI = 0.78-1.88), adalimumab (HR = 1.10, 95% CI = 0.72-1.68), and etanercept (HR = 1.27, 95% CI = 0.83-1.95). CONCLUSIONS: In RA patients treated with SL BIO, a 30-44% higher hazard of all infection was observed in anti-TNFs versus rituximab with a 62% higher hazard of severe infection observed in infliximab versus rituximab. This study used a non-randomized, observational design and is therefore subject to confounding from unmeasured factors that influence both treatment choice and infection risk.
OBJECTIVE: This study compared the incidence and hazard of ICD-9-CM-coded infections and severe infections in rheumatoid arthritis (RA) patients treated with subsequent-line (SL) BIOs (BIO) after switching from first-line (FL) anti-TNF therapy (anti-TNF). METHODS: Retrospective analysis of a large U.S. claims database. RApatients initiating an FL anti-TNF between 1/1/2004 and 3/31/2010 were identified and followed forward in time to capture all SL BIO episodes through 3/31/2010. SL BIO episodes were classified into: abatacept, adalimumab, etanercept, infliximab, or rituximab. Multivariate mixed-effects survival models compared the hazard of infections and severe infections across the SL BIO episodes with adjustment for demographic and clinical confounders. RESULTS: In total, 4332 SL BIO episodes were identified: mean age 55 years; 80% female. In adjusted analyses: when compared to rituximab, the hazard of all infections was significantly higher for adalimumab (hazard ratio [HR] = 1.31, 95% confidence interval [CI] = 1.09-1.55), etanercept (HR = 1.44, 95% CI = 1.20-1.72), and infliximab (HR = 1.30, 95% CI = 1.07-1.57), and insignificantly different for abatacept (HR = 1.18, 95% CI = 0.98-1.41); when compared to rituximab, the hazard of severe infection was significantly higher for infliximab (HR = 1.62, 95% CI = 1.03-2.55), and insignificantly different for abatacept (HR = 1.21, 95% CI = 0.78-1.88), adalimumab (HR = 1.10, 95% CI = 0.72-1.68), and etanercept (HR = 1.27, 95% CI = 0.83-1.95). CONCLUSIONS: In RApatients treated with SL BIO, a 30-44% higher hazard of all infection was observed in anti-TNFs versus rituximab with a 62% higher hazard of severe infection observed in infliximab versus rituximab. This study used a non-randomized, observational design and is therefore subject to confounding from unmeasured factors that influence both treatment choice and infection risk.
Authors: Huifeng Yun; Fenglong Xie; Elizabeth Delzell; Lang Chen; Emily B Levitan; James D Lewis; Kenneth G Saag; Timothy Beukelman; Kevin Winthrop; John W Baddley; Jeffrey R Curtis Journal: Ann Rheum Dis Date: 2014-03-07 Impact factor: 19.103
Authors: Ryan Galea; Hendrik J Nel; Meghna Talekar; Xiao Liu; Joshua D Ooi; Megan Huynh; Sara Hadjigol; Kate J Robson; Yi Tian Ting; Suzanne Cole; Karyn Cochlin; Shannon Hitchcock; Bijun Zeng; Suman Yekollu; Martine Boks; Natalie Goh; Helen Roberts; Jamie Rossjohn; Hugh H Reid; Ben J Boyd; Ravi Malaviya; David J Shealy; Daniel G Baker; Loui Madakamutil; A Richard Kitching; Brendan J O'Sullivan; Ranjeny Thomas Journal: JCI Insight Date: 2019-09-19
Authors: J R Curtis; S Yang; N M Patkar; L Chen; J A Singh; G W Cannon; T R Mikuls; E Delzell; K G Saag; M M Safford; S DuVall; K Alexander; P Napalkov; Kevin L Winthrop; M J Burton; A Kamauu; J W Baddley Journal: Arthritis Care Res (Hoboken) Date: 2014-07 Impact factor: 4.794
Authors: Rishi J Desai; Daniel H Solomon; Michael E Weinblatt; Nancy Shadick; Seoyoung C Kim Journal: Arthritis Res Ther Date: 2015-04-13 Impact factor: 5.156
Authors: Leslie R Harrold; George W Reed; Chitra Karki; Robert Magner; Ashwini Shewade; Ani John; Joel M Kremer; Jeffrey D Greenberg Journal: Arthritis Care Res (Hoboken) Date: 2016-12 Impact factor: 4.794