TY - JOUR
T1 - Infection risk in patients with rheumatoid arthritis treated with etanercept or adalimumab
AU - Chiang, Yi Chun
AU - Kuo, Li Na
AU - Yen, Yu Hsuan
AU - Tang, Chao Hsiun
AU - Chen, Hsiang Yin
N1 - Funding Information:
This work was supported by a research grant from the National Science Council Taiwan ( 98-2410-H-038-002 ) and from Wan Fang Hospital, Taipei Medical University ( 100-WF-EVA-21 ). The study was based on partial data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance (BNHI) and managed by the National Health Research Institutes (NHRI). However, the interpretation and conclusions described herein do not represent policies of the BNHI or NHRI.
PY - 2014/10
Y1 - 2014/10
N2 - Objectives: To compare the risk of infection for rheumatoid arthritis (RA) patients who took etanercept or adalimumab medication in a nationwide population. Methods: RA patients who took etanercept or adalimumab were identified in the Taiwan's National Health Insurance Research Database. The composite outcome of serious infections, including hospitalization for infection, reception of an antimicrobial injection, and tuberculosis were followed for 365 days. A Kaplan-Meier survival curve with a log-rank test and Cox proportional hazards regression were used to compare risks of infection between the two cohorts of tumor necrosis factor (TNF)-α antagonists users. Hazard ratios (HRs) were obtained and adjusted with propensity scores and clinical factors. Sensitivity analyses and subgroup analyses were also performed. Results: In total, 1660 incident etanercept users and 484 incident adalimumab users were eligible for the analysis. The unadjusted HR for infection of the etanercept users was significantly higher than that of the adalimumab users (HR: 1.93; 95% confidence interval (CI): 1.09-3.42; p= 0.024). The HRs were 2.04 (95% CI: 1.14-3.65; p= 0.016) and 2.02 (95% CI: 1.13-3.61; p= 0.018) after adjusting for propensity scores and for propensity scores in addition to clinical factors, respectively. The subgroup analyses revealed that HRs for composite infection was significantly higher in patient subgroups of older age, female, as well as patients who did not have DM, COPD, and hospitalization history at the baseline. Conclusion: In this head-to-head cohort study involving a nationwide population of patients with RA, etanercept users demonstrated a higher risk of infection than adalimumab users. Results of this study suggest the possible existence of an intra-class difference in infection risk among TNF-α antagonists.
AB - Objectives: To compare the risk of infection for rheumatoid arthritis (RA) patients who took etanercept or adalimumab medication in a nationwide population. Methods: RA patients who took etanercept or adalimumab were identified in the Taiwan's National Health Insurance Research Database. The composite outcome of serious infections, including hospitalization for infection, reception of an antimicrobial injection, and tuberculosis were followed for 365 days. A Kaplan-Meier survival curve with a log-rank test and Cox proportional hazards regression were used to compare risks of infection between the two cohorts of tumor necrosis factor (TNF)-α antagonists users. Hazard ratios (HRs) were obtained and adjusted with propensity scores and clinical factors. Sensitivity analyses and subgroup analyses were also performed. Results: In total, 1660 incident etanercept users and 484 incident adalimumab users were eligible for the analysis. The unadjusted HR for infection of the etanercept users was significantly higher than that of the adalimumab users (HR: 1.93; 95% confidence interval (CI): 1.09-3.42; p= 0.024). The HRs were 2.04 (95% CI: 1.14-3.65; p= 0.016) and 2.02 (95% CI: 1.13-3.61; p= 0.018) after adjusting for propensity scores and for propensity scores in addition to clinical factors, respectively. The subgroup analyses revealed that HRs for composite infection was significantly higher in patient subgroups of older age, female, as well as patients who did not have DM, COPD, and hospitalization history at the baseline. Conclusion: In this head-to-head cohort study involving a nationwide population of patients with RA, etanercept users demonstrated a higher risk of infection than adalimumab users. Results of this study suggest the possible existence of an intra-class difference in infection risk among TNF-α antagonists.
KW - Adalimumab
KW - Etanercept
KW - Infection
KW - Rheumatoid arthritis
KW - Tumor necrosis factor-α antagonist
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U2 - 10.1016/j.cmpb.2014.06.008
DO - 10.1016/j.cmpb.2014.06.008
M3 - Article
C2 - 25022467
AN - SCOPUS:84904471725
SN - 0169-2607
VL - 116
SP - 319
EP - 327
JO - Computer Methods and Programs in Biomedicine
JF - Computer Methods and Programs in Biomedicine
IS - 3
ER -