Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis.

Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Research Abstract Details 

Research Abstract Table of Contents

Jump to the:

Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Abstract Text:

Sebastian Schneeweiss,Soko Setoguchi,Michael E Weinblatt,Jeffrey N Katz,Jerry Avorn,Paul E Sax,Raisa Levin,Daniel H Solomon,

OBJECTIVE: To assess the association between the initiation of anti-tumor necrosis factor alpha (anti-TNFalpha) therapy and the risk of serious bacterial infections in routine care. METHODS: This was a cohort study of patients with rheumatoid arthritis (RA) in whom specific disease-modifying antirheumatic drugs (DMARDs) were initiated. Patients were Medicare beneficiaries ages 65 years and older (mean age 76.5 years) who were concurrently enrolled in the Pharmaceutical Assistance Contract for the Elderly provided by the state of Pennsylvania. A total of 15,597 RA patients in whom a DMARD was initiated between January 1, 1995 and December 31, 2003 were identified using linked data on all prescription drug dispensings, physician services, and hospitalizations. Initiation of anti-TNFalpha therapy, cytotoxic agents other than methotrexate (MTX), noncytotoxic agents, and glucocorticoids was compared with initiation of MTX. The main outcome measure was serious bacterial infections that required hospitalization. RESULTS: The incidence of serious bacterial infections was, on average, 2.2 per 100 patient-years in this population (95% confidence interval [95% CI] 2.0-2.4). Glucocorticoid use doubled the rate of serious bacterial infections as compared with MTX use, independent of previous DMARD use (rate ratio [RR] 2.1 [95% CI 1.5-3.1]), with a clear dose-response relationship for dosages >5 mg/day (for < or = 5 mg/day, RR 1.34; for 6-9 mg/day, RR 1.53; for 10-19 mg/day, RR 2.97; and for > or = 20 mg/day, RR 5.48 [P for trend < 0.0001]). Adjusted models showed no increase in the rate of serious infections among initiators of anti-TNFalpha therapy (RR 1.0 [95% CI 0.6-1.7]) or other DMARDs as compared with initiators of MTX. CONCLUSION: In a large cohort of patients with RA, we found no increase in serious bacterial infections among users of anti-TNFalpha therapy compared with users of MTX. Glucocorticoid use was associated with a dose-dependent increase in such infections.

Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Publishing Authors By Initials

S Schneeweiss,S Setoguchi,ME Weinblatt,JN Katz,J Avorn,PE Sax,R Levin,DH Solomon,

For similar peptides: intercellular signaling peptides and proteins: cytokines: monokines: tumor necrosis factor-alpha research abstracts see: peptides: intercellular signaling peptides and proteins: cytokines: monokines: tumor necrosis factor-alpha research

PUBMED ID PMID:

MEDLINE DATE:

Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Journal Published:

PUBLICATION TYPE: Research Support, Non-U.S. Gov

Journal: Arthritis and rheumatism

VOLUME: 56

Page Numbers: 1754-64

Journal Abbreviation: Arthritis Rheum.

ISSN: 0004-3591

DAY: 3

MONTH: Jun

YEAR: 2007

Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Information

Number of References:

LANGUAGE: eng

NlmUniqueID: 370605

Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Keywords Mesh Terms:

KEYWORDS: Tumor Necrosis Factor-alpha

MESH TERMS: antagonists & inhibitors

Chemical & Substance for Abstract: Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Information

Substance Name: Methotrexate

Registry Number: 59-05-2

Grant and Affiliation Information for Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis.

AFFILIATION: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02120, USA. schneeweiss@post.harvard.edu

Country: United States

AGENCY: United States NIAMS

GRANT: P60-AR-47782

ACRONYM: AR

MEDLINETA: Arthritis Rheum

REFSOURCE:

DATABASENAME:

ACCESSION NUMBER:

Number Hits: 0

Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis Related Publications

• Atrial fibrillation in patients after cardiovascular surgery : incidence, risk factors, preventive and therapeutic strategies.
• Comparison of human papillomavirus distribution in cytologic subgroups of low-grade squamous intraepithelial lesion.
• Distribution of azithromycin by community health volunteers in ghana.
• Fe L-edge X-ray absorption spectroscopy of low-spin heme relative to non-heme Fe complexes: delocalization of Fe d-electrons into the porphyrin ligand.
• Fe L-edge XAS studies of K4[Fe(CN)6] and K3[Fe(CN)6]: a direct probe of back-bonding.
• Group and organizational involvement among persons with psychiatric disabilities in supported housing.
• Identification of the peroxy adduct in multicopper oxidases by a combination of computational chemistry and extended X-ray absorption fine-structure measurements.
• Inhibiting the renin-angiotensin system in myocardial infarction and heart failure: lessons from SAVE, VALIANT and CHARM, and other clinical trials.
• Intramolecular single-turnover reaction in a cytochrome C oxidase model bearing a Tyr244 mimic.
• Kinetic and spectroscopic studies of N694C lipoxygenase: a probe of the substrate activation mechanism of a nonheme ferric enzyme.
• Mad3p, a pseudosubstrate inhibitor of APCCdc20 in the spindle assembly checkpoint.
• Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function.
• Physician follow-up and provider continuity are associated with long-term medication adherence: a study of the dynamics of statin use.
• Predictors of stroke in high-risk patients after acute myocardial infarction: insights from the VALIANT Trial.
• Radioimaging of light chain amyloid with a fibril-reactive monoclonal antibody.
• Randomized, double-masked clinical trial evaluating corneal endothelial cell loss after cataract extraction and intraocular lens implantation: Fluid-based system versus ultrasound phacoemulsification.
• Spectroscopic and electronic structure studies of the role of active site interactions in the decarboxylation reaction of alpha-keto acid-dependent dioxygenases.
• Spectroscopic and electronic structure study of the enzyme-substrate complex of intradiol dioxygenases: substrate activation by a high-spin ferric non-heme iron site.
• Spectroscopic methods in bioinorganic chemistry: blue to green to red copper sites.
• Spectroscopic, computational, and kinetic studies of the mu4-sulfide-bridged tetranuclear CuZ cluster in N2O reductase: pH effect on the edge ligand and its contribution to reactivity.
• Sulfur K-edge X-ray absorption spectroscopy as a probe of ligand-metal bond covalency: metal vs ligand oxidation in copper and nickel dithiolene complexes.
• Sulfur K-edge XAS and DFT studies on NiII complexes with oxidized thiolate ligands: implications for the roles of oxidized thiolates in the active sites of Fe and Co nitrile hydratase.
• The children's computerized physical activity reporter: children as partners in the design and usability evaluation of an application for self-reporting physical activity.
• The impact of psychiatric comorbidity on general hospital length of stay.
• The importance of being discrete: life always wins on the surface.
• The two-state issue in the mixed-valence binuclear CuA center in cytochrome C oxidase and N2O reductase.
• Transit of hormonal and EGF receptor-dependent signals through cholesterol-rich membranes.
• What is orofacial fatigue and how does it affect function for swallowing and speech?
• What's new in trichiasis surgery?
• X-ray absorption edge spectroscopy and computational studies on LCuO2 species: Superoxide-Cu(II) versus peroxide-Cu(III) bonding.