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 : 001481 ( Main/Exploration ); précédent : 001480; suivant : 001482The 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 [Royaume-Uni, Canada] ; A. Kezouh [Canada] ; S. Bernatsky [Canada] ; S. Suissa [Canada]Source :
- 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
Affiliations:
- Canada, Royaume-Uni
- Angleterre, Grand Manchester, Québec
- Manchester, Montréal
- Université McGill, Université de Manchester
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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><affiliations><list><country><li>Canada</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Manchester</li><li>Québec</li></region><settlement><li>Manchester</li><li>Montréal</li></settlement><orgName><li>Université McGill</li><li>Université de Manchester</li></orgName></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Dixon, W G" sort="Dixon, W G" uniqKey="Dixon W" first="W G" last="Dixon">W G Dixon</name></region></country><country name="Canada"><region name="Québec"><name sortKey="Dixon, W G" sort="Dixon, W G" uniqKey="Dixon W" first="W G" last="Dixon">W G Dixon</name></region><name sortKey="Bernatsky, S" sort="Bernatsky, S" uniqKey="Bernatsky S" first="S" last="Bernatsky">S. Bernatsky</name><name sortKey="Kezouh, A" sort="Kezouh, A" uniqKey="Kezouh A" first="A" last="Kezouh">A. Kezouh</name><name sortKey="Suissa, S" sort="Suissa, S" uniqKey="Suissa S" first="S" last="Suissa">S. Suissa</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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