TY - JOUR T1 - Rates of Serious Infections and Malignancies Among Patients with Rheumatoid Arthritis Receiving Either Tumor Necrosis Factor Inhibitor or Rituximab Therapy JF - The Journal of Rheumatology JO - J Rheumatol DO - 10.3899/jrheum.140853 SP - jrheum.140853 AU - Kalle Jyri Aaltonen AU - Jaana Tuulikki Joensuu AU - Liisa Virkki AU - Tuulikki Sokka AU - Pasi Aronen AU - Heikki Relas AU - Heikki Valleala AU - Vappu Rantalaiho AU - Laura Pirilä AU - Kari Puolakka AU - Tea Uusitalo AU - Marja Blom AU - Yrjö Tapio Konttinen AU - Dan Nordström Y1 - 2015/01/15 UR - http://www.jrheum.org/content/early/2015/01/07/jrheum.140853.abstract N2 - Objective Because of the role of tumor necrosis factor (TNF) in host defense, it was hypothesized that its inhibition might lead to an increased risk of malignancies and infections. The objective of our study was to assess the incidence of serious infections leading to hospitalization and malignancies among patients with rheumatoid arthritis (RA) receiving either TNF inhibitor or rituximab (RTX) therapy. Methods The study population was identified from the National Register for Biologic Treatment in Finland and the hospital records of Central Finland Central Hospital for conventional disease-modifying antirheumatic drug (cDMARD) users. Data on infections and malignancies were acquired from national healthcare registers. A Poisson model was used to calculate the adjusted incidence rate ratios (aIRR) and was composed of age, sex, time from diagnosis, year of the beginning of the followup, rheumatoid factor status, Disease Activity Score at 28 joints, Health Assessment Questionnaire, prior malignancy, prior serious infection, prior biologic use, and time-updated use of methotrexate, sulfasalazine, hydroxychloroquine, and oral corticosteroids as confounders. Results In total, during the followup of 10,994 patient-years, 92 malignancies and 341 serious infections were included in the analyses. The aIRR of infections compared to cDMARD users were 1.2 (95% CI 0.63–2.3), 0.84 (95% CI 0.53–1.3), 0.98 (95% CI 0.60–1.6), and 1.1 (95% CI 0.59–1.9) for the patients treated with infliximab (IFX), etanercept, adalimumab, and RTX, respectively. The crude rates of malignancies were highest among the users of cDMARD and RTX, and lowest among patients treated with IFX with no differences in aIRR. Conclusion Our results provide some reassurance of the safety of biologic treatments in the treatment of RA. ER -