Discontinuation of anti-TNF-α therapy in a Chinese cohort of patients with rheumatoid arthritis
Identifieur interne : 000417 ( Istex/Corpus ); précédent : 000416; suivant : 000418Discontinuation of anti-TNF-α therapy in a Chinese cohort of patients with rheumatoid arthritis
Auteurs : Cheng-Tao Yang ; Chang-Fu Kuo ; Shue-Fen Luo ; Kuang-Hui YuSource :
- Clinical Rheumatology [ 0770-3198 ] ; 2012-11-01.
English descriptors
Abstract
Abstract: The aim of this retrospective study was to examine the predictors of discontinuation of anti-tumor necrosis factor (TNF) therapy due to adverse events in Chinese patients with rheumatoid arthritis (RA). Anti-TNF-related adverse events were recorded and analyzed in 217 consecutive patients with RA followed in our institution from 2003 to 2010. Time to discontinuation of anti-TNF-α therapy was estimated using survival analysis techniques. The anti-TNF agents administered were etanercept in 181 patients and adalimumab in 36 patients. The mean age at diagnosis was 45.2 ± 13.5 years, and mean age at initiation of anti-TNF therapy was 51.8 ± 13.0 years. The mean duration of anti-TNF agent use was 36.0 ± 26.5 months (range, 1.4–87.0; median, 26.4 months). Of the 217 patients, 39 (18.0 %) developed adverse events [etanercept in 34 (18.8 %] and adalimumab in 5 (13.9 %)] during the treatment period (tuberculosis in 5, bacterial infections in 19, virus infection in 7, neuropathy in 3, malignancy in 3, other drug-related events in 1, and appendicitis in 1). In patients with RA, older age (≥55 years) at initiation of anti-TNF therapy [odds ratio (OR), 3.20; 95 % confidence interval (CI), 1.67–6.20; p < 0.001], Cr ≥1.5 mg/dL (OR, 5.72; 95 % CI, 1.17–27.90; p = 0.031), and occurrence of adverse events (OR, 3.82; 95 % CI, 1.75–8.35; p = 0.001) were associated with increased likelihood of discontinuation of anti-TNF treatment. In the present study, a significant proportion (7.8 %, 17/217) of patients with RA discontinued anti-TNF treatment because of adverse events. In the elderly and in patients with renal insufficiency, caution is needed when starting anti-TNF treatment.
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DOI: 10.1007/s10067-012-2047-8
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ISTEX:80AED66D1E9BB21FCEB9D3512D4C9B28C0A5C5FBLe document en format XML
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Tao-Yuan, Taiwan</mods:affiliation></affiliation></author><author><name sortKey="Luo, Shue Fen" sort="Luo, Shue Fen" uniqKey="Luo S" first="Shue-Fen" last="Luo">Shue-Fen Luo</name><affiliation><mods:affiliation>Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan</mods:affiliation></affiliation></author><author><name sortKey="Yu, Kuang Hui" sort="Yu, Kuang Hui" uniqKey="Yu K" first="Kuang-Hui" last="Yu">Kuang-Hui Yu</name><affiliation><mods:affiliation>Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan</mods:affiliation></affiliation><affiliation><mods:affiliation>Division of Allergy, Immunology and Rheumatology, Chang Gung Memorial Hospital, 5 Fu-Shin St., Kuei-Shan (333), Tao-Yuan County, Taiwan</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: gout@adm.cgmh.org.tw</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Clinical Rheumatology</title><title level="j" type="sub">Journal of the International League of Associations for Rheumatology</title><title level="j" type="abbrev">Clin Rheumatol</title><idno type="ISSN">0770-3198</idno><idno type="eISSN">1434-9949</idno><imprint><publisher>Springer-Verlag</publisher><pubPlace>London</pubPlace><date type="published" when="2012-11-01">2012-11-01</date><biblScope unit="volume">31</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1549">1549</biblScope><biblScope unit="page" to="1557">1557</biblScope></imprint><idno type="ISSN">0770-3198</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0770-3198</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adverse event</term><term>Infection</term><term>Rheumatoid arthritis</term><term>Tumor necrosis factor</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: The aim of this retrospective study was to examine the predictors of discontinuation of anti-tumor necrosis factor (TNF) therapy due to adverse events in Chinese patients with rheumatoid arthritis (RA). Anti-TNF-related adverse events were recorded and analyzed in 217 consecutive patients with RA followed in our institution from 2003 to 2010. Time to discontinuation of anti-TNF-α therapy was estimated using survival analysis techniques. The anti-TNF agents administered were etanercept in 181 patients and adalimumab in 36 patients. The mean age at diagnosis was 45.2 ± 13.5 years, and mean age at initiation of anti-TNF therapy was 51.8 ± 13.0 years. The mean duration of anti-TNF agent use was 36.0 ± 26.5 months (range, 1.4–87.0; median, 26.4 months). Of the 217 patients, 39 (18.0 %) developed adverse events [etanercept in 34 (18.8 %] and adalimumab in 5 (13.9 %)] during the treatment period (tuberculosis in 5, bacterial infections in 19, virus infection in 7, neuropathy in 3, malignancy in 3, other drug-related events in 1, and appendicitis in 1). In patients with RA, older age (≥55 years) at initiation of anti-TNF therapy [odds ratio (OR), 3.20; 95 % confidence interval (CI), 1.67–6.20; p < 0.001], Cr ≥1.5 mg/dL (OR, 5.72; 95 % CI, 1.17–27.90; p = 0.031), and occurrence of adverse events (OR, 3.82; 95 % CI, 1.75–8.35; p = 0.001) were associated with increased likelihood of discontinuation of anti-TNF treatment. In the present study, a significant proportion (7.8 %, 17/217) of patients with RA discontinued anti-TNF treatment because of adverse events. In the elderly and in patients with renal insufficiency, caution is needed when starting anti-TNF treatment.</div></front></TEI><istex><corpusName>springer-journals</corpusName><author><json:item><name>Cheng-Tao Yang</name><affiliations><json:string>Division of Chinese Medicine, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan</json:string></affiliations></json:item><json:item><name>Chang-Fu Kuo</name><affiliations><json:string>Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan</json:string></affiliations></json:item><json:item><name>Shue-Fen Luo</name><affiliations><json:string>Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan</json:string></affiliations></json:item><json:item><name>Kuang-Hui Yu</name><affiliations><json:string>Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan</json:string><json:string>Division of Allergy, Immunology and Rheumatology, Chang Gung Memorial Hospital, 5 Fu-Shin St., Kuei-Shan (333), Tao-Yuan County, Taiwan</json:string><json:string>E-mail: gout@adm.cgmh.org.tw</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Adverse event</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Infection</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Rheumatoid arthritis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Tumor necrosis factor</value></json:item></subject><articleId><json:string>2047</json:string><json:string>s10067-012-2047-8</json:string></articleId><arkIstex>ark:/67375/VQC-187FRHJV-K</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>OriginalPaper</json:string></originalGenre><abstract>Abstract: The aim of this retrospective study was to examine the predictors of discontinuation of anti-tumor necrosis factor (TNF) therapy due to adverse events in Chinese patients with rheumatoid arthritis (RA). Anti-TNF-related adverse events were recorded and analyzed in 217 consecutive patients with RA followed in our institution from 2003 to 2010. Time to discontinuation of anti-TNF-α therapy was estimated using survival analysis techniques. The anti-TNF agents administered were etanercept in 181 patients and adalimumab in 36 patients. The mean age at diagnosis was 45.2 ± 13.5 years, and mean age at initiation of anti-TNF therapy was 51.8 ± 13.0 years. The mean duration of anti-TNF agent use was 36.0 ± 26.5 months (range, 1.4–87.0; median, 26.4 months). Of the 217 patients, 39 (18.0 %) developed adverse events [etanercept in 34 (18.8 %] and adalimumab in 5 (13.9 %)] during the treatment period (tuberculosis in 5, bacterial infections in 19, virus infection in 7, neuropathy in 3, malignancy in 3, other drug-related events in 1, and appendicitis in 1). In patients with RA, older age (≥55 years) at initiation of anti-TNF therapy [odds ratio (OR), 3.20; 95 % confidence interval (CI), 1.67–6.20; p > 0.001], Cr ≥1.5 mg/dL (OR, 5.72; 95 % CI, 1.17–27.90; p = 0.031), and occurrence of adverse events (OR, 3.82; 95 % CI, 1.75–8.35; p = 0.001) were associated with increased likelihood of discontinuation of anti-TNF treatment. In the present study, a significant proportion (7.8 %, 17/217) of patients with RA discontinued anti-TNF treatment because of adverse events. In the elderly and in patients with renal insufficiency, caution is needed when starting anti-TNF treatment.</abstract><qualityIndicators><refBibsNative>false</refBibsNative><abstractWordCount>243</abstractWordCount><abstractCharCount>1694</abstractCharCount><keywordCount>4</keywordCount><score>9.767</score><pdfWordCount>4851</pdfWordCount><pdfCharCount>34169</pdfCharCount><pdfVersion>1.4</pdfVersion><pdfPageCount>9</pdfPageCount><pdfPageSize>595.276 x 790.866 pts</pdfPageSize></qualityIndicators><title>Discontinuation of anti-TNF-α therapy in a Chinese cohort of patients with rheumatoid arthritis</title><genre><json:string>research-article</json:string></genre><host><title>Clinical 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type="first">Kuang-Hui</forename><surname>Yu</surname></persName><email>gout@adm.cgmh.org.tw</email><affiliation>Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan</affiliation><affiliation>Division of Allergy, Immunology and Rheumatology, Chang Gung Memorial Hospital, 5 Fu-Shin St., Kuei-Shan (333), Tao-Yuan County, Taiwan</affiliation></author><idno type="istex">80AED66D1E9BB21FCEB9D3512D4C9B28C0A5C5FB</idno><idno type="ark">ark:/67375/VQC-187FRHJV-K</idno><idno type="DOI">10.1007/s10067-012-2047-8</idno><idno type="article-id">2047</idno><idno type="article-id">s10067-012-2047-8</idno></analytic><monogr><title level="j">Clinical Rheumatology</title><title level="j" type="sub">Journal of the International League of Associations for Rheumatology</title><title level="j" type="abbrev">Clin Rheumatol</title><idno type="pISSN">0770-3198</idno><idno type="eISSN">1434-9949</idno><idno type="journal-ID">true</idno><idno type="issue-article-count">17</idno><idno type="volume-issue-count">12</idno><imprint><publisher>Springer-Verlag</publisher><pubPlace>London</pubPlace><date type="published" when="2012-11-01"></date><biblScope unit="volume">31</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1549">1549</biblScope><biblScope unit="page" to="1557">1557</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2012-02-02</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Abstract: The aim of this retrospective study was to examine the predictors of discontinuation of anti-tumor necrosis factor (TNF) therapy due to adverse events in Chinese patients with rheumatoid arthritis (RA). Anti-TNF-related adverse events were recorded and analyzed in 217 consecutive patients with RA followed in our institution from 2003 to 2010. Time to discontinuation of anti-TNF-α therapy was estimated using survival analysis techniques. The anti-TNF agents administered were etanercept in 181 patients and adalimumab in 36 patients. The mean age at diagnosis was 45.2 ± 13.5 years, and mean age at initiation of anti-TNF therapy was 51.8 ± 13.0 years. The mean duration of anti-TNF agent use was 36.0 ± 26.5 months (range, 1.4–87.0; median, 26.4 months). Of the 217 patients, 39 (18.0 %) developed adverse events [etanercept in 34 (18.8 %] and adalimumab in 5 (13.9 %)] during the treatment period (tuberculosis in 5, bacterial infections in 19, virus infection in 7, neuropathy in 3, malignancy in 3, other drug-related events in 1, and appendicitis in 1). In patients with RA, older age (≥55 years) at initiation of anti-TNF therapy [odds ratio (OR), 3.20; 95 % confidence interval (CI), 1.67–6.20; p < 0.001], Cr ≥1.5 mg/dL (OR, 5.72; 95 % CI, 1.17–27.90; p = 0.031), and occurrence of adverse events (OR, 3.82; 95 % CI, 1.75–8.35; p = 0.001) were associated with increased likelihood of discontinuation of anti-TNF treatment. In the present study, a significant proportion (7.8 %, 17/217) of patients with RA discontinued anti-TNF treatment because of adverse events. In the elderly and in patients with renal insufficiency, caution is needed when starting anti-TNF treatment.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Adverse event</term></item><item><term>Infection</term></item><item><term>Rheumatoid arthritis</term></item><item><term>Tumor necrosis factor</term></item></list></keywords></textClass><textClass><keywords scheme="Journal-Subject-Collection"><list><label>Medicine</label><item><term>SC11</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>Medicine & Public Health</head><item><term>Rheumatology</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2012-02-02">Created</change><change 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Article</ArticleCategory><ArticleFirstPage>1549</ArticleFirstPage><ArticleLastPage>1557</ArticleLastPage><ArticleHistory><RegistrationDate><Year>2012</Year><Month>7</Month><Day>18</Day></RegistrationDate><Received><Year>2012</Year><Month>2</Month><Day>2</Day></Received><Revised><Year>2012</Year><Month>7</Month><Day>17</Day></Revised><Accepted><Year>2012</Year><Month>7</Month><Day>17</Day></Accepted><OnlineDate><Year>2012</Year><Month>7</Month><Day>31</Day></OnlineDate></ArticleHistory><ArticleCopyright><CopyrightHolderName>Clinical Rheumatology</CopyrightHolderName><CopyrightYear>2012</CopyrightYear></ArticleCopyright><ArticleGrants Type="Regular"><MetadataGrant Grant="OpenAccess"></MetadataGrant><AbstractGrant Grant="OpenAccess"></AbstractGrant><BodyPDFGrant Grant="Restricted"></BodyPDFGrant><BodyHTMLGrant Grant="Restricted"></BodyHTMLGrant><BibliographyGrant Grant="Restricted"></BibliographyGrant><ESMGrant Grant="Restricted"></ESMGrant></ArticleGrants></ArticleInfo><ArticleHeader><AuthorGroup><Author AffiliationIDS="Aff1"><AuthorName DisplayOrder="Western"><GivenName>Cheng-Tao</GivenName><FamilyName>Yang</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff2"><AuthorName DisplayOrder="Western"><GivenName>Chang-Fu</GivenName><FamilyName>Kuo</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff2"><AuthorName DisplayOrder="Western"><GivenName>Shue-Fen</GivenName><FamilyName>Luo</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff2 Aff3" CorrespondingAffiliationID="Aff3"><AuthorName DisplayOrder="Western"><GivenName>Kuang-Hui</GivenName><FamilyName>Yu</FamilyName></AuthorName><Contact><Email>gout@adm.cgmh.org.tw</Email></Contact></Author><Affiliation ID="Aff1"><OrgDivision>Division of Chinese Medicine</OrgDivision><OrgName>Chang Gung Memorial Hospital and Chang Gung University</OrgName><OrgAddress><City>Tao-Yuan</City><Country Code="TW">Taiwan</Country></OrgAddress></Affiliation><Affiliation ID="Aff2"><OrgDivision>Division of Rheumatology, Allergy and Immunology</OrgDivision><OrgName>Chang Gung Memorial Hospital and Chang Gung University</OrgName><OrgAddress><City>Tao-Yuan</City><Country Code="TW">Taiwan</Country></OrgAddress></Affiliation><Affiliation ID="Aff3"><OrgDivision>Division of Allergy, Immunology and Rheumatology</OrgDivision><OrgName>Chang Gung Memorial Hospital</OrgName><OrgAddress><Street>5 Fu-Shin St., Kuei-Shan (333)</Street><City>Tao-Yuan County</City><Country Code="TW">Taiwan</Country></OrgAddress></Affiliation></AuthorGroup><Abstract ID="Abs1" Language="En" OutputMedium="All"><Heading>Abstract</Heading><Para>The aim of this retrospective study was to examine the predictors of discontinuation of anti-tumor necrosis factor (TNF) therapy due to adverse events in Chinese patients with rheumatoid arthritis (RA). Anti-TNF-related adverse events were recorded and analyzed in 217 consecutive patients with RA followed in our institution from 2003 to 2010. Time to discontinuation of anti-TNF-α therapy was estimated using survival analysis techniques. The anti-TNF agents administered were etanercept in 181 patients and adalimumab in 36 patients. The mean age at diagnosis was 45.2 ± 13.5 years, and mean age at initiation of anti-TNF therapy was 51.8 ± 13.0 years. The mean duration of anti-TNF agent use was 36.0 ± 26.5 months (range, 1.4–87.0; median, 26.4 months). Of the 217 patients, 39 (18.0 %) developed adverse events [etanercept in 34 (18.8 %] and adalimumab in 5 (13.9 %)] during the treatment period (tuberculosis in 5, bacterial infections in 19, virus infection in 7, neuropathy in 3, malignancy in 3, other drug-related events in 1, and appendicitis in 1). In patients with RA, older age (≥55 years) at initiation of anti-TNF therapy [odds ratio (OR), 3.20; 95 % confidence interval (CI), 1.67–6.20; <Emphasis Type="Italic">p</Emphasis> < 0.001], Cr ≥1.5 mg/dL (OR, 5.72; 95 % CI, 1.17–27.90; <Emphasis Type="Italic">p</Emphasis> = 0.031), and occurrence of adverse events (OR, 3.82; 95 % CI, 1.75–8.35; <Emphasis Type="Italic">p</Emphasis> = 0.001) were associated with increased likelihood of discontinuation of anti-TNF treatment. In the present study, a significant proportion (7.8 %, 17/217) of patients with RA discontinued anti-TNF treatment because of adverse events. In the elderly and in patients with renal insufficiency, caution is needed when starting anti-TNF treatment.</Para></Abstract><KeywordGroup Language="En" OutputMedium="All"><Heading>Keywords</Heading><Keyword>Adverse event</Keyword><Keyword>Infection</Keyword><Keyword>Rheumatoid arthritis</Keyword><Keyword>Tumor necrosis factor</Keyword></KeywordGroup></ArticleHeader><NoBody></NoBody></Article></Issue></Volume></Journal></Publisher></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Discontinuation of anti-TNF-α therapy in a Chinese cohort of patients with rheumatoid arthritis</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Discontinuation of anti-TNF-α therapy in a Chinese cohort of patients with rheumatoid arthritis</title></titleInfo><name type="personal"><namePart type="given">Cheng-Tao</namePart><namePart type="family">Yang</namePart><affiliation>Division of Chinese Medicine, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Chang-Fu</namePart><namePart type="family">Kuo</namePart><affiliation>Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Shue-Fen</namePart><namePart type="family">Luo</namePart><affiliation>Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Kuang-Hui</namePart><namePart type="family">Yu</namePart><affiliation>Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan</affiliation><affiliation>Division of Allergy, Immunology and Rheumatology, Chang Gung Memorial Hospital, 5 Fu-Shin St., Kuei-Shan (333), Tao-Yuan County, Taiwan</affiliation><affiliation>E-mail: gout@adm.cgmh.org.tw</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="OriginalPaper" 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>Springer-Verlag</publisher><place><placeTerm type="text">London</placeTerm></place><dateCreated encoding="w3cdtf">2012-02-02</dateCreated><dateIssued encoding="w3cdtf">2012-11-01</dateIssued><copyrightDate encoding="w3cdtf">2012</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><abstract lang="en">Abstract: The aim of this retrospective study was to examine the predictors of discontinuation of anti-tumor necrosis factor (TNF) therapy due to adverse events in Chinese patients with rheumatoid arthritis (RA). Anti-TNF-related adverse events were recorded and analyzed in 217 consecutive patients with RA followed in our institution from 2003 to 2010. Time to discontinuation of anti-TNF-α therapy was estimated using survival analysis techniques. The anti-TNF agents administered were etanercept in 181 patients and adalimumab in 36 patients. The mean age at diagnosis was 45.2 ± 13.5 years, and mean age at initiation of anti-TNF therapy was 51.8 ± 13.0 years. The mean duration of anti-TNF agent use was 36.0 ± 26.5 months (range, 1.4–87.0; median, 26.4 months). Of the 217 patients, 39 (18.0 %) developed adverse events [etanercept in 34 (18.8 %] and adalimumab in 5 (13.9 %)] during the treatment period (tuberculosis in 5, bacterial infections in 19, virus infection in 7, neuropathy in 3, malignancy in 3, other drug-related events in 1, and appendicitis in 1). In patients with RA, older age (≥55 years) at initiation of anti-TNF therapy [odds ratio (OR), 3.20; 95 % confidence interval (CI), 1.67–6.20; p < 0.001], Cr ≥1.5 mg/dL (OR, 5.72; 95 % CI, 1.17–27.90; p = 0.031), and occurrence of adverse events (OR, 3.82; 95 % CI, 1.75–8.35; p = 0.001) were associated with increased likelihood of discontinuation of anti-TNF treatment. In the present study, a significant proportion (7.8 %, 17/217) of patients with RA discontinued anti-TNF treatment because of adverse events. In the elderly and in patients with renal insufficiency, caution is needed when starting anti-TNF treatment.</abstract><note>Original Article</note><subject lang="en"><genre>Keywords</genre><topic>Adverse event</topic><topic>Infection</topic><topic>Rheumatoid arthritis</topic><topic>Tumor necrosis factor</topic></subject><relatedItem type="host"><titleInfo><title>Clinical Rheumatology</title><subTitle>Journal of the International League of Associations for Rheumatology</subTitle></titleInfo><titleInfo type="abbreviated"><title>Clin Rheumatol</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><originInfo><publisher>Springer</publisher><dateIssued encoding="w3cdtf">2012-10-30</dateIssued><copyrightDate encoding="w3cdtf">2012</copyrightDate></originInfo><subject><genre>Journal-Subject-Collection</genre><topic authority="SpringerSubjectCodes" authorityURI="Medicine">SC11</topic></subject><subject><genre>Medicine & Public Health</genre><topic>Rheumatology</topic></subject><identifier type="ISSN">0770-3198</identifier><identifier type="eISSN">1434-9949</identifier><identifier type="JournalID">10067</identifier><identifier type="IssueArticleCount">17</identifier><identifier type="VolumeIssueCount">12</identifier><part><date>2012</date><detail type="volume"><number>31</number><caption>vol.</caption></detail><detail type="issue"><number>11</number><caption>no.</caption></detail><extent unit="pages"><start>1549</start><end>1557</end></extent></part><recordInfo><recordOrigin>Clinical Rheumatology, 2012</recordOrigin></recordInfo></relatedItem><identifier type="istex">80AED66D1E9BB21FCEB9D3512D4C9B28C0A5C5FB</identifier><identifier type="ark">ark:/67375/VQC-187FRHJV-K</identifier><identifier type="DOI">10.1007/s10067-012-2047-8</identifier><identifier type="ArticleID">2047</identifier><identifier type="ArticleID">s10067-012-2047-8</identifier><accessCondition type="use and reproduction" contentType="copyright">Clinical Rheumatology, 2012</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-3XSW68JL-F">springer</recordContentSource><recordOrigin>Clinical Rheumatology, 2012</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/VQC-187FRHJV-K/record.json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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