Serious infections during anti-TNFα treatment in rheumatoid arthritis patients

Ennio Giulio Favalli, Francesca Desiati, Fabiola Atzeni, Piercarlo Sarzi-Puttini, Roberto Caporali, Francesca Bobbio Pallavicini, Roberto Gorla, Matteo Filippini, Antonio Marchesoni

Research output: Contribution to journalArticle

128 Citations (Scopus)

Abstract

The objective was to estimate the incidence of serious infections in the patients treated with anti-TNFα agents for rheumatoid arthritis (RA) recorded in the Lombardy Rheumatology Network (LORHEN) registry. The study inclusion criteria were met by 1064 of the 1114 patients with long-standing RA, 519 treated with infliximab, 303 with adalimumab, and 242 with etanercept; their mean age was 55.8 years and the mean duration of RA 9.4 years. Seventy-three patients (6.9%) experienced a total of 74 serious infections, an incidence rate for all treatment courses of 35.9 per 1000 patient-years (95% confidence interval [95% CI] 27.66-44.13). Most were lower respiratory tract (34.2%) or skin and soft tissue infections (20.5%). Of the 1064 patients, the 790 treated with anti-TNFα after March 2002 underwent screening tests for LTBI; five patients developed active tuberculosis. Three patients died of septic shock. The type of anti-TNFα agent did not seem to affect the incidence or site of the infections. Both univariate and multivariate analyses identified age at the start of anti-TNFα treatment (p = 0.008), baseline erythrocyte sedimentation rate ([ESR] p = 0.014), and the concomitant use of corticosteroids (p = 0.029) as significant predictors of infections. There was no statistically significant difference in risk between the anti-TNFα agents.

Original languageEnglish
Pages (from-to)266-273
Number of pages8
JournalAutoimmunity Reviews
Volume8
Issue number3
DOIs
Publication statusPublished - Jan 2009

Fingerprint

Rheumatoid Arthritis
Infection
Therapeutics
Incidence
Soft Tissue Infections
Blood Sedimentation
Rheumatology
Septic Shock
Respiratory System
Registries
Adrenal Cortex Hormones
Tuberculosis
Multivariate Analysis
Confidence Intervals
Skin

Keywords

  • Adalimumab
  • Anti-TNFα
  • Etanercept
  • Infection
  • Infliximab
  • Rheumatoid arthritis
  • Safety

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

Cite this

Serious infections during anti-TNFα treatment in rheumatoid arthritis patients. / Favalli, Ennio Giulio; Desiati, Francesca; Atzeni, Fabiola; Sarzi-Puttini, Piercarlo; Caporali, Roberto; Pallavicini, Francesca Bobbio; Gorla, Roberto; Filippini, Matteo; Marchesoni, Antonio.

In: Autoimmunity Reviews, Vol. 8, No. 3, 01.2009, p. 266-273.

Research output: Contribution to journalArticle

Favalli, EG, Desiati, F, Atzeni, F, Sarzi-Puttini, P, Caporali, R, Pallavicini, FB, Gorla, R, Filippini, M & Marchesoni, A 2009, 'Serious infections during anti-TNFα treatment in rheumatoid arthritis patients', Autoimmunity Reviews, vol. 8, no. 3, pp. 266-273. https://doi.org/10.1016/j.autrev.2008.11.002
Favalli, Ennio Giulio ; Desiati, Francesca ; Atzeni, Fabiola ; Sarzi-Puttini, Piercarlo ; Caporali, Roberto ; Pallavicini, Francesca Bobbio ; Gorla, Roberto ; Filippini, Matteo ; Marchesoni, Antonio. / Serious infections during anti-TNFα treatment in rheumatoid arthritis patients. In: Autoimmunity Reviews. 2009 ; Vol. 8, No. 3. pp. 266-273.
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