Long-term anti-TNF therapy and the risk of serious infections in a cohort of patients with rheumatoid arthritis: Comparison of adalimumab, etanercept and infliximab in the GISEA registry

被引：141

作者：

Atzeni, Fabiola ^{[1
]}

Sarzi-Puttini, Piercarlo ^{[1
]}

Botsios, Costantino ^{[2
]}

Carletto, Antonio ^{[3
]}

Cipriani, Paola ^{[4
]}

Favalli, Ennio Giulio ^{[5
]}

Frati, Elena ^{[6
]}

Foschi, Valentina ^{[7
]}

Gasparini, Stefania ^{[8
]}

Giardina, AnnaRita ^{[9
]}

Gremese, Elisa ^{[10
]}

Iannone, Florenzo ^{[11
]}

Sebastiani, Marco ^{[12
]}

Ziglioli, Tamara ^{[13
]}

Biasi, Domenico ^{[3
]}

Ferri, Clodoveo ^{[12
]}

Galeazzi, Mauro ^{[7
]}

Gerli, Roberto ^{[14
]}

Giacomelli, Roberto ^{[4
]}

Gorla, Roberto ^{[13
]}

Govoni, Marcello ^{[7
]}

Lapadula, Giovanni ^{[11
]}

Marchesoni, Antonio ^{[5
]}

Salaffi, Fausto ^{[8
]}

Punzi, Leonardo ^{[2
]}

Triolo, Giovanni ^{[9
]}

Ferraccioli, Gianfranco ^{[10
]}

机构：

[1] L Sacco Univ Hosp, Rheumatol Unit, Milan, Italy

[2] Univ Padua, Rheumatol Unit, Padua, Italy

[3] Univ Verona, Rheumatol Unit, I-37100 Verona, Italy

[4] Univ Aquila, Rheumatol Unit, I-67100 Laquila, Italy

[5] Osped G Pini, Rheumatol Unit, Milan, Italy

[6] Univ Siena, Rheumatol Unit, I-53100 Siena, Italy

[7] Univ Ferrara, Rheumatol Unit, I-44100 Ferrara, Italy

[8] Polytech Univ Marche, Rheumatol Unit, Ancona, Italy

[9] Univ Palermo, Rheumatol Unit, Palermo, Italy

[10] Catholic Univ, Rheumatol Unit, Rome, Italy

[11] Univ Bari, Rheumatol Unit, Bari, Italy

[12] Univ Modena & Reggio Emilia, Rheumatol Unit, Modena, Italy

[13] Univ Brescia, Rheumatol Unit, Brescia, Italy

[14] Univ Perugia, Rheumatol Unit, I-06100 Perugia, Italy

来源：

AUTOIMMUNITY REVIEWS | 2012年 / 12卷 / 02期

关键词：

GISEA register; Infections; Anti-TNF agents; Predictive factors; TUMOR-NECROSIS-FACTOR; BIOLOGICS-REGISTER; BRITISH-SOCIETY; SAFETY; ALPHA; METAANALYSIS; ANTAGONISTS; DISEASES; HEALTH;

D O I：

10.1016/j.autrev.2012.06.008

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

071005 [微生物学]; 100108 [医学免疫学];

摘要：

Objective: To evaluate the risk of serious infections (SIs) in RA patients receiving anti-TNF therapy on the basis of the data included in the GISEA register. Methods: The study involved 2769 adult patients with long-standing RA (mean age 53.2 +/- 13.4 years; mean disease duration 9.0 +/- 8.3 years) enrolled in the GISEA register, who had been treated for at least 6 months with TNF inhibitors or had discontinued therapy due to SI: 837 (30%) treated with infliximab (IFN), 802 (29%) with adalimumab (ADA), and 1130 (41%) with etanercept (ETN). Results: 176 patients had experienced at least one of the 226 Sis during the 9 years of treatment with an anti-TNF agent, an overall incidence of 31.8/1000 patient-years (95% CI 25.2-38.3): 23.7/1000 patient-years (95% CI 13.1-34.2) on ADA; 12.8/1000 patient-years (95% CI 6.3-19.4) on ETN and 65.1/1000 patient-years (95% CI 48.4-81.8) on IFN. The risk was higher in the first than in the second year of treatment, but this difference was not statistically significant (p = 0.08) (38.9% of the SIs were recorded in the first 12 months of treatment). The risk of SI was significantly different among the three treatment groups (p<0.0001). Multivariate models confirmed that the use of steroids (p<0.046), concomitant DMARD treatment during anti-TNF therapy (p=0.004), advanced age at the start of anti-TNF treatment (p<0.0001), and the use of IFN or ADA rather than ETN (respectively p<0.0001 and p = 0.023) were strong and statistically significant predictors of infection. Conclusions: Anti-TNF therapy is associated with a small but significant risk of SI that is associated with the concomitant use of steroids, advanced age at the start of anti-TNF treatment, and the type of anti-TNF agent. (C) 2012 Elsevier B.V. All rights reserved.

引用

页码：225 / 229

页数：5

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