TNF-α Antagonists Do Not Up Infection Hospitalizations

In autoimmune disease, infection hospitalization risk similar to that with nonbiologic medication

WEDNESDAY, Nov. 9 (HealthDay News) -- For patients with autoimmune diseases, tumor necrosis factor (TNF)-α antagonist use is not associated with a significant increase in serious infections requiring hospitalization, compared to nonbiologic medication use, according to a study published online Nov. 6 in the Journal of the American Medical Association.

Carlos G. Grijalva, M.D., M.P.H., from Vanderbilt University in Nashville, Tenn., and colleagues investigated whether the use of TNF-α antagonists is associated with the risk of serious infections requiring hospitalization versus nonbiologic comparator medications in retrospective cohorts of patients with auto-immune diseases (assembled between 1998 and 2007). The cohorts were matched by disease-specific propensity score for comparing TNF-α antagonist use with nonbiologic comparators (10,484 rheumatoid arthritis [RA], 2,323 inflammatory bowel disease [IBD], and 3,215 psoriasis and spondyloarthropathies matched pairs). Baseline glucocorticoid use was assessed separately. The main outcome measured was infection requiring hospitalization during the first 12 months after initiation of either treatment.

The investigators found that, of the 1,172 serious infections identified, 53 percent were pneumonia and skin and soft tissue infections. Serious infection hospitalization rates were not statistically significantly different for patients with RA, IBD, or psoriasis and spondyloarthropathies taking TNF-α antagonists versus the comparator regimen. Compared with use of etanercept and adalimumab, for patients with RA, the use of infliximab correlated with a significantly elevated risk of serious infections (adjusted hazard ratio, 1.26). Baseline use of glucocorticoids correlated with a dose-dependent increase in infections.

"Initiation of TNF-α antagonists was not associated with an increased risk of hospitalizations for serious infections," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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