RT Journal Article
SR Electronic
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
FD The Journal of Rheumatology
SP 372
OP 378
DO 10.3899/jrheum.140853
VO 42
IS 3
A1 Kalle Jyri Aaltonen
A1 Jaana Tuulikki Joensuu
A1 Liisa Virkki
A1 Tuulikki Sokka
A1 Pasi Aronen
A1 Heikki Relas
A1 Heikki Valleala
A1 Vappu Rantalaiho
A1 Laura Pirilä
A1 Kari Puolakka
A1 Tea Uusitalo
A1 Marja Blom
A1 Yrjö Tapio Konttinen
A1 Dan Nordström
YR 2015
UL http://www.jrheum.org/content/42/3/372.abstract
AB 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.