Infection risk in patients with rheumatoid arthritis treated with etanercept or adalimumab

Yi Chun Chiang, Li Na Kuo, Yu Hsuan Yen, Chao Hsiun Tang, Hsiang Yin Chen

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)319-327
Number of pages9
JournalComputer Methods and Programs in Biomedicine
Volume116
Issue number3
DOIs
Publication statusPublished - 2014

Fingerprint

Rheumatoid Arthritis
Hazards
Infection
Propensity Score
Confidence Intervals
Health insurance
Hospitalization
Tumor Necrosis Factor-alpha
Composite materials
Adalimumab
Etanercept
Kaplan-Meier Estimate
National Health Programs
Taiwan
Chronic Obstructive Pulmonary Disease
Population
Tuberculosis
Cohort Studies
History
Databases

Keywords

  • Adalimumab
  • Etanercept
  • Infection
  • Rheumatoid arthritis
  • Tumor necrosis factor-α antagonist

ASJC Scopus subject areas

  • Computer Science Applications
  • Software
  • Health Informatics
  • Medicine(all)

Cite this

Infection risk in patients with rheumatoid arthritis treated with etanercept or adalimumab. / Chiang, Yi Chun; Kuo, Li Na; Yen, Yu Hsuan; Tang, Chao Hsiun; Chen, Hsiang Yin.

In: Computer Methods and Programs in Biomedicine, Vol. 116, No. 3, 2014, p. 319-327.

Research output: Contribution to journalArticle

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abstract = "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.",
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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.

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