The influence of systemic glucocorticoid therapy upon the risk of non-serious infection in older patients with rheumatoid arthritis: a nested case–control study
Identifieur interne : 000320 ( Istex/Corpus ); précédent : 000319; suivant : 000321The influence of systemic glucocorticoid therapy upon the risk of non-serious infection in older patients with rheumatoid arthritis: a nested case–control study
Auteurs : W G Dixon ; A. Kezouh ; S. Bernatsky ; S. SuissaSource :
- Annals of the Rheumatic Diseases [ 0003-4967 ] ; 2011-06.
English descriptors
- Teeft :
- Antirheumatic, Antirheumatic drug, Antirheumatic drugs, Arthritis, Attributable risk, Baseline characteristics, Billing code, Cardiovascular disease, Clinical epidemiology, Cohort, Cohort entry, Combination antirheumatic drug, Comorbidity, Concurrent dmard therapy, Confounders, Crude rate, Current dmard, Current drug, Current exposure, Current glucocorticoid exposure, Current glucocorticoid therapy, Daily dose, Database, Disease severity, Dmard, Dmard prescription, Dmard therapy, Dose categories, Drug category, Drug product database, Entry date, Epidemiology unit, Gastric drugs, Glucocorticoid, Glucocorticoid exposure, Glucocorticoid therapy, Herpes zoster, High disease severity, High risk, Higher risk, Hospital specialist visits, Incidence rates, Index date, Infection, Injectable glucocorticoid therapy, Interstitial lung disease, Mcgill university, Medical services database, Methotrexate, Methotrexate sulfasalazine azathioprine cyclophosphamide therapy gold others, Mycophenolate mofetil, Older patients, Oral glucocorticoid exposure, Oral glucocorticoid therapy, Other drugs, Prescription, Prescription database, Pulmonary disease, Report table, Review board, Rheum, Rheumatoid, Rheumatoid arthritis, Rheumatologist visits, Sensitivity analysis, Serious infection, Serious infections, Statistical analysis, Study period, Systemic glucocorticoid injection, Systemic glucocorticoid therapy, Therapy, Unexposed person time, Whole cohort, Whole population.
Abstract
Background Glucocorticoid therapy is strongly associated with an elevated risk of serious infections in patients with rheumatoid arthritis (RA). The association between glucocorticoids and common non-serious infections (NSI) is not well studied. Methods A cohort of 16 207 patients with RA aged over 65 years was assembled using administrative data from Quebec. Glucocorticoid and disease-modifying antirheumatic drug (DMARD) therapy were identified from drug dispensing records. NSI cases were defined as first occurrence of a community physician billing code for infection or community-dispensed anti-infectives. A nested case–control analysis was performed considering drugs dispensed within 45 days of the index date, adjusting for age, sex, markers of disease severity, DMARD and comorbidity. Results For 13 634 subjects, a NSI occurred during 28 695 person-years of follow-up, generating an incidence rate of 47.5/100 person-years. The crude rate of NSI in glucocorticoid-exposed and unexposed person time was 52.4 and 38.8/100 person-years, respectively. Glucocorticoid therapy was associated with an adjusted RR of 1.20 (95% CI 1.15 to 1.25). A dose response was seen, the adjusted RR increasing from 1.10 (<5 mg prednisolone/day) to 1.85 for doses greater than 20 mg/day. All glucocorticoid risk estimates (including <5 mg/day) were higher than that seen for methotrexate (adjusted RR 1.00; 0.95 to 1.04). Conclusion Glucocorticoid therapy is associated with an increased risk of NSI. The magnitude of risk increases with dose, and is higher than that seen with methotrexate, although residual confounding may exist. While the RR is low at 1.20, the absolute risk is high with one additional infection seen for every 13 patients treated with glucocorticoids for 1 year.
Url:
DOI: 10.1136/ard.2010.144741
Links to Exploration step
ISTEX:8A6B8E3D4A036B8A6A44324CA0242D49FDEE8012Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>The influence of systemic glucocorticoid therapy upon the risk of non-serious infection in older patients with rheumatoid arthritis: a nested case–control study</title><author><name sortKey="Dixon, W G" sort="Dixon, W G" uniqKey="Dixon W" first="W G" last="Dixon">W G Dixon</name><affiliation><mods:affiliation>Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre,The University of Manchester, Manchester, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</mods:affiliation></affiliation></author><author><name sortKey="Kezouh, A" sort="Kezouh, A" uniqKey="Kezouh A" first="A" last="Kezouh">A. Kezouh</name><affiliation><mods:affiliation>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</mods:affiliation></affiliation></author><author><name sortKey="Bernatsky, S" sort="Bernatsky, S" uniqKey="Bernatsky S" first="S" last="Bernatsky">S. Bernatsky</name><affiliation><mods:affiliation>Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada</mods:affiliation></affiliation></author><author><name sortKey="Suissa, S" sort="Suissa, S" uniqKey="Suissa S" first="S" last="Suissa">S. Suissa</name><affiliation><mods:affiliation>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:8A6B8E3D4A036B8A6A44324CA0242D49FDEE8012</idno><date when="2011" year="2011">2011</date><idno type="doi">10.1136/ard.2010.144741</idno><idno type="url">https://api.istex.fr/ark:/67375/NVC-KL6TZTQC-4/fulltext.pdf</idno><idno type="wicri:Area/Istex/Corpus">000320</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000320</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">The influence of systemic glucocorticoid therapy upon the risk of non-serious infection in older patients with rheumatoid arthritis: a nested case–control study</title><author><name sortKey="Dixon, W G" sort="Dixon, W G" uniqKey="Dixon W" first="W G" last="Dixon">W G Dixon</name><affiliation><mods:affiliation>Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre,The University of Manchester, Manchester, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</mods:affiliation></affiliation></author><author><name sortKey="Kezouh, A" sort="Kezouh, A" uniqKey="Kezouh A" first="A" last="Kezouh">A. Kezouh</name><affiliation><mods:affiliation>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</mods:affiliation></affiliation></author><author><name sortKey="Bernatsky, S" sort="Bernatsky, S" uniqKey="Bernatsky S" first="S" last="Bernatsky">S. Bernatsky</name><affiliation><mods:affiliation>Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada</mods:affiliation></affiliation></author><author><name sortKey="Suissa, S" sort="Suissa, S" uniqKey="Suissa S" first="S" last="Suissa">S. Suissa</name><affiliation><mods:affiliation>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Annals of the Rheumatic Diseases</title><title level="j" type="abbrev">Ann Rheum Dis</title><idno type="ISSN">0003-4967</idno><idno type="eISSN">1468-2060</idno><imprint><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><date type="published" when="2011-06">2011-06</date><biblScope unit="volume">70</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="956">956</biblScope></imprint><idno type="ISSN">0003-4967</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0003-4967</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Antirheumatic</term><term>Antirheumatic drug</term><term>Antirheumatic drugs</term><term>Arthritis</term><term>Attributable risk</term><term>Baseline characteristics</term><term>Billing code</term><term>Cardiovascular disease</term><term>Clinical epidemiology</term><term>Cohort</term><term>Cohort entry</term><term>Combination antirheumatic drug</term><term>Comorbidity</term><term>Concurrent dmard therapy</term><term>Confounders</term><term>Crude rate</term><term>Current dmard</term><term>Current drug</term><term>Current exposure</term><term>Current glucocorticoid exposure</term><term>Current glucocorticoid therapy</term><term>Daily dose</term><term>Database</term><term>Disease severity</term><term>Dmard</term><term>Dmard prescription</term><term>Dmard therapy</term><term>Dose categories</term><term>Drug category</term><term>Drug product database</term><term>Entry date</term><term>Epidemiology unit</term><term>Gastric drugs</term><term>Glucocorticoid</term><term>Glucocorticoid exposure</term><term>Glucocorticoid therapy</term><term>Herpes zoster</term><term>High disease severity</term><term>High risk</term><term>Higher risk</term><term>Hospital specialist visits</term><term>Incidence rates</term><term>Index date</term><term>Infection</term><term>Injectable glucocorticoid therapy</term><term>Interstitial lung disease</term><term>Mcgill university</term><term>Medical services database</term><term>Methotrexate</term><term>Methotrexate sulfasalazine azathioprine cyclophosphamide therapy gold others</term><term>Mycophenolate mofetil</term><term>Older patients</term><term>Oral glucocorticoid exposure</term><term>Oral glucocorticoid therapy</term><term>Other drugs</term><term>Prescription</term><term>Prescription database</term><term>Pulmonary disease</term><term>Report table</term><term>Review board</term><term>Rheum</term><term>Rheumatoid</term><term>Rheumatoid arthritis</term><term>Rheumatologist visits</term><term>Sensitivity analysis</term><term>Serious infection</term><term>Serious infections</term><term>Statistical analysis</term><term>Study period</term><term>Systemic glucocorticoid injection</term><term>Systemic glucocorticoid therapy</term><term>Therapy</term><term>Unexposed person time</term><term>Whole cohort</term><term>Whole population</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background Glucocorticoid therapy is strongly associated with an elevated risk of serious infections in patients with rheumatoid arthritis (RA). The association between glucocorticoids and common non-serious infections (NSI) is not well studied. Methods A cohort of 16 207 patients with RA aged over 65 years was assembled using administrative data from Quebec. Glucocorticoid and disease-modifying antirheumatic drug (DMARD) therapy were identified from drug dispensing records. NSI cases were defined as first occurrence of a community physician billing code for infection or community-dispensed anti-infectives. A nested case–control analysis was performed considering drugs dispensed within 45 days of the index date, adjusting for age, sex, markers of disease severity, DMARD and comorbidity. Results For 13 634 subjects, a NSI occurred during 28 695 person-years of follow-up, generating an incidence rate of 47.5/100 person-years. The crude rate of NSI in glucocorticoid-exposed and unexposed person time was 52.4 and 38.8/100 person-years, respectively. Glucocorticoid therapy was associated with an adjusted RR of 1.20 (95% CI 1.15 to 1.25). A dose response was seen, the adjusted RR increasing from 1.10 (<5 mg prednisolone/day) to 1.85 for doses greater than 20 mg/day. All glucocorticoid risk estimates (including <5 mg/day) were higher than that seen for methotrexate (adjusted RR 1.00; 0.95 to 1.04). Conclusion Glucocorticoid therapy is associated with an increased risk of NSI. The magnitude of risk increases with dose, and is higher than that seen with methotrexate, although residual confounding may exist. While the RR is low at 1.20, the absolute risk is high with one additional infection seen for every 13 patients treated with glucocorticoids for 1 year.</div></front></TEI><istex><corpusName>bmj</corpusName><keywords><teeft><json:string>glucocorticoid</json:string><json:string>glucocorticoid therapy</json:string><json:string>dmard</json:string><json:string>cohort</json:string><json:string>database</json:string><json:string>rheumatoid</json:string><json:string>rheumatoid arthritis</json:string><json:string>index date</json:string><json:string>methotrexate</json:string><json:string>antirheumatic</json:string><json:string>disease severity</json:string><json:string>confounders</json:string><json:string>comorbidity</json:string><json:string>serious infection</json:string><json:string>rheum</json:string><json:string>cohort entry</json:string><json:string>systemic glucocorticoid therapy</json:string><json:string>billing code</json:string><json:string>oral glucocorticoid therapy</json:string><json:string>older patients</json:string><json:string>serious infections</json:string><json:string>arthritis</json:string><json:string>dmard therapy</json:string><json:string>sensitivity analysis</json:string><json:string>higher risk</json:string><json:string>antirheumatic drugs</json:string><json:string>attributable risk</json:string><json:string>mycophenolate mofetil</json:string><json:string>rheumatologist visits</json:string><json:string>whole cohort</json:string><json:string>study period</json:string><json:string>prescription database</json:string><json:string>current drug</json:string><json:string>dmard prescription</json:string><json:string>glucocorticoid exposure</json:string><json:string>current exposure</json:string><json:string>mcgill university</json:string><json:string>infection</json:string><json:string>therapy</json:string><json:string>drug product database</json:string><json:string>whole population</json:string><json:string>high risk</json:string><json:string>medical services database</json:string><json:string>incidence rates</json:string><json:string>concurrent dmard therapy</json:string><json:string>review board</json:string><json:string>other drugs</json:string><json:string>cardiovascular disease</json:string><json:string>unexposed person time</json:string><json:string>entry date</json:string><json:string>crude rate</json:string><json:string>antirheumatic drug</json:string><json:string>pulmonary disease</json:string><json:string>interstitial lung disease</json:string><json:string>gastric drugs</json:string><json:string>report table</json:string><json:string>statistical analysis</json:string><json:string>methotrexate sulfasalazine azathioprine cyclophosphamide therapy gold others</json:string><json:string>combination antirheumatic drug</json:string><json:string>drug category</json:string><json:string>hospital specialist visits</json:string><json:string>current glucocorticoid therapy</json:string><json:string>current glucocorticoid exposure</json:string><json:string>clinical epidemiology</json:string><json:string>dose categories</json:string><json:string>epidemiology unit</json:string><json:string>systemic glucocorticoid injection</json:string><json:string>injectable glucocorticoid therapy</json:string><json:string>oral glucocorticoid exposure</json:string><json:string>daily dose</json:string><json:string>current dmard</json:string><json:string>herpes zoster</json:string><json:string>high disease severity</json:string><json:string>baseline characteristics</json:string><json:string>prescription</json:string></teeft></keywords><author><json:item><name>W G Dixon</name><affiliations><json:string>Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre,The University of Manchester, Manchester, UK</json:string><json:string>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</json:string></affiliations></json:item><json:item><name>A Kezouh</name><affiliations><json:string>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</json:string></affiliations></json:item><json:item><name>S Bernatsky</name><affiliations><json:string>Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada</json:string></affiliations></json:item><json:item><name>S Suissa</name><affiliations><json:string>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</json:string></affiliations></json:item></author><articleId><json:string>annrheumdis144741</json:string></articleId><arkIstex>ark:/67375/NVC-KL6TZTQC-4</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Background Glucocorticoid therapy is strongly associated with an elevated risk of serious infections in patients with rheumatoid arthritis (RA). The association between glucocorticoids and common non-serious infections (NSI) is not well studied. Methods A cohort of 16 207 patients with RA aged over 65 years was assembled using administrative data from Quebec. Glucocorticoid and disease-modifying antirheumatic drug (DMARD) therapy were identified from drug dispensing records. NSI cases were defined as first occurrence of a community physician billing code for infection or community-dispensed anti-infectives. A nested case–control analysis was performed considering drugs dispensed within 45 days of the index date, adjusting for age, sex, markers of disease severity, DMARD and comorbidity. Results For 13 634 subjects, a NSI occurred during 28 695 person-years of follow-up, generating an incidence rate of 47.5/100 person-years. The crude rate of NSI in glucocorticoid-exposed and unexposed person time was 52.4 and 38.8/100 person-years, respectively. Glucocorticoid therapy was associated with an adjusted RR of 1.20 (95% CI 1.15 to 1.25). A dose response was seen, the adjusted RR increasing from 1.10 (>5 mg prednisolone/day) to 1.85 for doses greater than 20 mg/day. All glucocorticoid risk estimates (including >5 mg/day) were higher than that seen for methotrexate (adjusted RR 1.00; 0.95 to 1.04). Conclusion Glucocorticoid therapy is associated with an increased risk of NSI. The magnitude of risk increases with dose, and is higher than that seen with methotrexate, although residual confounding may exist. While the RR is low at 1.20, the absolute risk is high with one additional infection seen for every 13 patients treated with glucocorticoids for 1 year.</abstract><qualityIndicators><score>9.317</score><pdfWordCount>4317</pdfWordCount><pdfCharCount>28904</pdfCharCount><pdfVersion>1.6</pdfVersion><pdfPageCount>5</pdfPageCount><pdfPageSize>595.277 x 793.702 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>263</abstractWordCount><abstractCharCount>1778</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>The influence of systemic glucocorticoid therapy upon the risk of non-serious infection in older patients with rheumatoid arthritis: a nested case–control study</title><pmid><json:string>21285116</json:string></pmid><genre><json:string>research-article</json:string></genre><host><title>Annals of the Rheumatic Diseases</title><language><json:string>unknown</json:string></language><issn><json:string>0003-4967</json:string></issn><eissn><json:string>1468-2060</json:string></eissn><publisherId><json:string>ard</json:string></publisherId><volume>70</volume><issue>6</issue><pages><first>956</first></pages><genre><json:string>journal</json:string></genre><subject><json:item><value>Unlocked</value></json:item></subject></host><namedEntities><unitex><date><json:string>2011-02-01</json:string></date><geogName></geogName><orgName><json:string>Central Manchester Foundation Trust</json:string><json:string>Division of Clinical Epidemiology</json:string><json:string>ICD, International Classi</json:string><json:string>Arthritis Research UK Epidemiology Unit, The University of Manchester, Stopford Building, Oxford Road, Manchester</json:string><json:string>Ministry of Health</json:string><json:string>Canadian Foundation for Innovation</json:string><json:string>Health Canada</json:string><json:string>CFI</json:string><json:string>Canada Correspondence</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Ann Rheum</json:string><json:string>Davis Institute</json:string><json:string>Extended</json:string></persName><placeName><json:string>UK</json:string><json:string>Montreal</json:string><json:string>Canada</json:string><json:string>Quebec</json:string></placeName><ref_url><json:string>http://ard.bmj</json:string></ref_url><ref_bibl></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/NVC-KL6TZTQC-4</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - rheumatology</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - arthritis & rheumatology</json:string></scienceMetrix><scopus><json:string>1 - Life Sciences</json:string><json:string>2 - Biochemistry, Genetics and Molecular Biology</json:string><json:string>3 - General Biochemistry, Genetics and Molecular Biology</json:string><json:string>1 - Life Sciences</json:string><json:string>2 - Immunology and Microbiology</json:string><json:string>3 - Immunology</json:string><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Immunology and Allergy</json:string><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Rheumatology</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string><json:string>4 - pathologie osteoarticulaire</json:string></inist></categories><publicationDate>2011</publicationDate><copyrightDate>2011</copyrightDate><doi><json:string>10.1136/ard.2010.144741</json:string></doi><id>8A6B8E3D4A036B8A6A44324CA0242D49FDEE8012</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-KL6TZTQC-4/fulltext.pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-KL6TZTQC-4/bundle.zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/ark:/67375/NVC-KL6TZTQC-4/fulltext.tei"><teiHeader><fileDesc><titleStmt><title level="a">The influence of systemic glucocorticoid therapy upon the risk of non-serious infection in older patients with rheumatoid arthritis: a nested case–control study</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://publisher-list.data.istex.fr">BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><availability status="free"><p>Open Access</p></availability><date>2011-02-01</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">The influence of systemic glucocorticoid therapy upon the risk of non-serious infection in older patients with rheumatoid arthritis: a nested case–control study</title><author xml:id="author-0000"><persName><forename type="first">W G</forename><surname>Dixon</surname></persName><affiliation>Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre,The University of Manchester, Manchester, UK</affiliation><affiliation>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</affiliation></author><author xml:id="author-0001"><persName><forename type="first">A</forename><surname>Kezouh</surname></persName><affiliation>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</affiliation></author><author xml:id="author-0002"><persName><forename type="first">S</forename><surname>Bernatsky</surname></persName><affiliation>Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada</affiliation></author><author xml:id="author-0003"><persName><forename type="first">S</forename><surname>Suissa</surname></persName><affiliation>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</affiliation></author><idno type="istex">8A6B8E3D4A036B8A6A44324CA0242D49FDEE8012</idno><idno type="ark">ark:/67375/NVC-KL6TZTQC-4</idno><idno type="DOI">10.1136/ard.2010.144741</idno><idno type="href">annrheumdis-70-956.pdf</idno><idno type="article-id">annrheumdis144741</idno><idno type="PMID">21285116</idno><idno type="local">annrheumdis;70/6/956</idno></analytic><monogr><title level="j">Annals of the Rheumatic Diseases</title><title level="j" type="abbrev">Ann Rheum Dis</title><idno type="pISSN">0003-4967</idno><idno type="eISSN">1468-2060</idno><idno type="publisher-id">ard</idno><idno type="PublisherID-hwp">annrheumdis</idno><idno type="PublisherID-nlm-ta">Ann Rheum Dis</idno><imprint><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><date type="published" when="2011-06"></date><biblScope unit="volume">70</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="956">956</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011-02-01</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background Glucocorticoid therapy is strongly associated with an elevated risk of serious infections in patients with rheumatoid arthritis (RA). The association between glucocorticoids and common non-serious infections (NSI) is not well studied. Methods A cohort of 16 207 patients with RA aged over 65 years was assembled using administrative data from Quebec. Glucocorticoid and disease-modifying antirheumatic drug (DMARD) therapy were identified from drug dispensing records. NSI cases were defined as first occurrence of a community physician billing code for infection or community-dispensed anti-infectives. A nested case–control analysis was performed considering drugs dispensed within 45 days of the index date, adjusting for age, sex, markers of disease severity, DMARD and comorbidity. Results For 13 634 subjects, a NSI occurred during 28 695 person-years of follow-up, generating an incidence rate of 47.5/100 person-years. The crude rate of NSI in glucocorticoid-exposed and unexposed person time was 52.4 and 38.8/100 person-years, respectively. Glucocorticoid therapy was associated with an adjusted RR of 1.20 (95% CI 1.15 to 1.25). A dose response was seen, the adjusted RR increasing from 1.10 (<5 mg prednisolone/day) to 1.85 for doses greater than 20 mg/day. All glucocorticoid risk estimates (including <5 mg/day) were higher than that seen for methotrexate (adjusted RR 1.00; 0.95 to 1.04). Conclusion Glucocorticoid therapy is associated with an increased risk of NSI. The magnitude of risk increases with dose, and is higher than that seen with methotrexate, although residual confounding may exist. While the RR is low at 1.20, the absolute risk is high with one additional infection seen for every 13 patients treated with glucocorticoids for 1 year.</p></abstract><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Unlocked</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2011-02-01">Created</change><change when="2011-06">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-KL6TZTQC-4/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">annrheumdis</journal-id><journal-id journal-id-type="nlm-ta">Ann Rheum Dis</journal-id><journal-id journal-id-type="publisher-id">ard</journal-id><journal-title>Annals of the Rheumatic Diseases</journal-title><abbrev-journal-title abbrev-type="publisher">Ann Rheum Dis</abbrev-journal-title><abbrev-journal-title>Ann Rheum Dis</abbrev-journal-title><issn pub-type="ppub">0003-4967</issn><issn pub-type="epub">1468-2060</issn><publisher><publisher-name>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">annrheumdis144741</article-id><article-id pub-id-type="doi">10.1136/ard.2010.144741</article-id><article-id pub-id-type="other">annrheumdis;70/6/956</article-id><article-id pub-id-type="other">annrheumdis;ard.2010.144741</article-id><article-id pub-id-type="pmid">21285116</article-id><article-id pub-id-type="other">956</article-id><article-id pub-id-type="other">ard.2010.144741</article-id><article-categories><subj-group subj-group-type="heading"><subject>Clinical and epidemiological research</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Unlocked</subject></subj-group><series-title>Extended report</series-title></article-categories><title-group><article-title>The influence of systemic glucocorticoid therapy upon the risk of non-serious infection in older patients with rheumatoid arthritis: a nested case–control study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Dixon</surname><given-names>W G</given-names></name><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Kezouh</surname><given-names>A</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Bernatsky</surname><given-names>S</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Suissa</surname><given-names>S</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib></contrib-group><aff id="A1"><label>1</label>Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre,The University of Manchester, Manchester, UK</aff><aff id="A2"><label>2</label>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</aff><aff id="A3"><label>3</label>Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada</aff><author-notes><corresp><label>Correspondence to</label> Dr W G Dixon, Arthritis Research UK Epidemiology Unit, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK; <email xlink:type="simple">will.dixon@manchester.ac.uk</email></corresp></author-notes><pub-date pub-type="ppub"><month>6</month><year>2011</year></pub-date><pub-date pub-type="epub-original"><day>1</day><month>2</month><year>2011</year></pub-date><pub-date pub-type="epub"><day>1</day><month>2</month><year>2011</year></pub-date><volume>70</volume><volume-id pub-id-type="other">70</volume-id><volume-id pub-id-type="other">70</volume-id><issue>6</issue><issue-id pub-id-type="other">annrheumdis;70/6</issue-id><issue-id pub-id-type="other">6</issue-id><issue-id pub-id-type="other">70/6</issue-id><fpage>956</fpage><history><date date-type="accepted"><day>2</day><month>1</month><year>2011</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2011</copyright-year><license license-type="open-access"><p>This paper is freely available online under the BMJ Journals unlocked scheme, see <ext-link xlink:href="http://ard.bmj.com/info/unlocked.dtl" ext-link-type="uri">http://ard.bmj.com/info/unlocked.dtl</ext-link></p></license></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="annrheumdis-70-956.pdf"></self-uri><abstract><sec><title>Background</title><p>Glucocorticoid therapy is strongly associated with an elevated risk of serious infections in patients with rheumatoid arthritis (RA). The association between glucocorticoids and common non-serious infections (NSI) is not well studied.</p></sec><sec><title>Methods</title><p>A cohort of 16 207 patients with RA aged over 65 years was assembled using administrative data from Quebec. Glucocorticoid and disease-modifying antirheumatic drug (DMARD) therapy were identified from drug dispensing records. NSI cases were defined as first occurrence of a community physician billing code for infection or community-dispensed anti-infectives. A nested case–control analysis was performed considering drugs dispensed within 45 days of the index date, adjusting for age, sex, markers of disease severity, DMARD and comorbidity.</p></sec><sec><title>Results</title><p>For 13 634 subjects, a NSI occurred during 28 695 person-years of follow-up, generating an incidence rate of 47.5/100 person-years. The crude rate of NSI in glucocorticoid-exposed and unexposed person time was 52.4 and 38.8/100 person-years, respectively. Glucocorticoid therapy was associated with an adjusted RR of 1.20 (95% CI 1.15 to 1.25). A dose response was seen, the adjusted RR increasing from 1.10 (<5 mg prednisolone/day) to 1.85 for doses greater than 20 mg/day. All glucocorticoid risk estimates (including <5 mg/day) were higher than that seen for methotrexate (adjusted RR 1.00; 0.95 to 1.04).</p></sec><sec><title>Conclusion</title><p>Glucocorticoid therapy is associated with an increased risk of NSI. The magnitude of risk increases with dose, and is higher than that seen with methotrexate, although residual confounding may exist. While the RR is low at 1.20, the absolute risk is high with one additional infection seen for every 13 patients treated with glucocorticoids for 1 year.</p></sec></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>The influence of systemic glucocorticoid therapy upon the risk of non-serious infection in older patients with rheumatoid arthritis: a nested case–control study</title><partName>Extended report</partName></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>The influence of systemic glucocorticoid therapy upon the risk of non-serious infection in older patients with rheumatoid arthritis: a nested case–control study</title><partName>Extended report</partName></titleInfo><name type="personal"><namePart type="given">W G</namePart><namePart type="family">Dixon</namePart><affiliation>Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre,The University of Manchester, Manchester, UK</affiliation><affiliation>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Kezouh</namePart><affiliation>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S</namePart><namePart type="family">Bernatsky</namePart><affiliation>Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S</namePart><namePart type="family">Suissa</namePart><affiliation>Centre for Clinical Epidemiology, Lady Davis Institute – Jewish General Hospital, McGill University, Montreal, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><dateIssued encoding="w3cdtf">2011-06</dateIssued><dateCreated encoding="w3cdtf">2011-02-01</dateCreated><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract>Background Glucocorticoid therapy is strongly associated with an elevated risk of serious infections in patients with rheumatoid arthritis (RA). The association between glucocorticoids and common non-serious infections (NSI) is not well studied. Methods A cohort of 16 207 patients with RA aged over 65 years was assembled using administrative data from Quebec. Glucocorticoid and disease-modifying antirheumatic drug (DMARD) therapy were identified from drug dispensing records. NSI cases were defined as first occurrence of a community physician billing code for infection or community-dispensed anti-infectives. A nested case–control analysis was performed considering drugs dispensed within 45 days of the index date, adjusting for age, sex, markers of disease severity, DMARD and comorbidity. Results For 13 634 subjects, a NSI occurred during 28 695 person-years of follow-up, generating an incidence rate of 47.5/100 person-years. The crude rate of NSI in glucocorticoid-exposed and unexposed person time was 52.4 and 38.8/100 person-years, respectively. Glucocorticoid therapy was associated with an adjusted RR of 1.20 (95% CI 1.15 to 1.25). A dose response was seen, the adjusted RR increasing from 1.10 (<5 mg prednisolone/day) to 1.85 for doses greater than 20 mg/day. All glucocorticoid risk estimates (including <5 mg/day) were higher than that seen for methotrexate (adjusted RR 1.00; 0.95 to 1.04). Conclusion Glucocorticoid therapy is associated with an increased risk of NSI. The magnitude of risk increases with dose, and is higher than that seen with methotrexate, although residual confounding may exist. While the RR is low at 1.20, the absolute risk is high with one additional infection seen for every 13 patients treated with glucocorticoids for 1 year.</abstract><relatedItem type="host"><titleInfo><title>Annals of the Rheumatic Diseases</title></titleInfo><titleInfo type="abbreviated"><title>Ann Rheum Dis</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>hwp-journal-coll</genre><topic>Unlocked</topic></subject><identifier type="ISSN">0003-4967</identifier><identifier type="eISSN">1468-2060</identifier><identifier type="PublisherID">ard</identifier><identifier type="PublisherID-hwp">annrheumdis</identifier><identifier type="PublisherID-nlm-ta">Ann Rheum Dis</identifier><part><date>2011</date><detail type="volume"><caption>vol.</caption><number>70</number></detail><detail type="issue"><caption>no.</caption><number>6</number></detail><extent unit="pages"><start>956</start></extent></part></relatedItem><identifier type="istex">8A6B8E3D4A036B8A6A44324CA0242D49FDEE8012</identifier><identifier type="ark">ark:/67375/NVC-KL6TZTQC-4</identifier><identifier type="DOI">10.1136/ard.2010.144741</identifier><identifier type="href">annrheumdis-70-956.pdf</identifier><identifier type="ArticleID">annrheumdis144741</identifier><identifier type="PMID">21285116</identifier><identifier type="local">annrheumdis;70/6/956</identifier><accessCondition type="use and reproduction" contentType="open-access">This paper is freely available online under the BMJ Journals unlocked scheme, see http://ard.bmj.com/info/unlocked.dtl</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-7M42M2QJ-2">bmj</recordContentSource><recordOrigin>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-KL6TZTQC-4/record.json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Sante/explor/ChloroquineV1/Data/Istex/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000320 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Istex/Corpus/biblio.hfd -nk 000320 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Sante
|area= ChloroquineV1
|flux= Istex
|étape= Corpus
|type= RBID
|clé= ISTEX:8A6B8E3D4A036B8A6A44324CA0242D49FDEE8012
|texte= The influence of systemic glucocorticoid therapy upon the risk of non-serious infection in older patients with rheumatoid arthritis: a nested case–control study
}}
| This area was generated with Dilib version V0.6.33. |  |