Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia.
Intern Med J. 2019 Apr;49(4):519-525. doi: 10.1111/imj.14109.
Biologic disease modifying anti-rheumatic drugs (bDMARDs) have significantly improved the prognosis for patients with rheumatoid arthritis (RA). However, due to their immunosuppressive nature, concerns remain about the potential for infection in patients receiving these medications.
To evaluate the incidence of serious infections (SI) in a Western Australian cohort of patients with RA who are receiving bDMARDs. The role of confounders including age, gender, comorbidities and use of glucocorticoids was also evaluated. The incidence of SI was defined as any infection necessitating admission to the hospital and the use of antibiotics.
A 10-year retrospective review was conducted of all patients with RA who were receiving bDMARDs at three tertiary hospitals in Western Australia. Discharge summaries and all available clinic letters were reviewed and patient demographics and clinical data were collected. Pearson Chi-squared test and Student's t-test were used for comparing demographic factors and clinical variables between the groups with SI and those without.
One hundred and two patients met the inclusion criteria for the period 2006-2016, 25 of whom had been admitted with SI, accounting for a total of 46 admissions. Skin and soft tissue infections were the most common (28%) followed by respiratory infections (26%) and urinary tract infections (20%). The incidence rate of SI was 8.98 per 100 person years. The rate was lowest with adalimumab (5.27 per 100 person years) and highest with infliximab (34.5 per 100 person years). Those with SI were older (68 years vs 60 years; P = 0.02) and had been on bDMARDs for longer period of time (6.05 years vs 4.68 years; P = 0.04). There was no significant increase in length of stay due to co-administration of glucocorticoids. The presence of comorbidities did not play a significant role in increasing the risk of SI.
Age and duration of bDMARD use were statistically significant factors associated with an increased risk of SI. Comorbidities did not play a significant role in increasing the incidence of SI. Patients who were on both glucocorticoids and bDMARDs did not have a significant increase in length of stay when compared with patients who were just on bDMARDs. More research is needed in this area with larger numbers to draw statistically significant conclusions regarding the role of comorbidities in SI risk and the individual infection risk associated with each bDMARD.
生物制剂类改善病情抗风湿药物（bDMARDs）显著改善了类风湿关节炎（RA）患者的预后。然而，由于其免疫抑制特性，人们仍然担心接受这些药物治疗的患者会发生感染。
评估在接受 bDMARDs 的西澳大利亚 RA 患者队列中严重感染（SI）的发生率。还评估了年龄、性别、合并症和糖皮质激素使用等混杂因素的作用。SI 的发生率定义为需要住院和使用抗生素的任何感染。
对西澳大利亚三家三级医院接受 bDMARDs 的所有 RA 患者进行了为期 10 年的回顾性研究。审查了出院小结和所有可用的门诊信件，并收集了患者的人口统计学和临床数据。使用 Pearson Chi-squared 检验和 Student's t 检验比较了有 SI 组和无 SI 组的人口统计学因素和临床变量。
在 2006 年至 2016 年期间，共有 102 名患者符合纳入标准，其中 25 名患者因 SI 住院，共 46 人次。皮肤和软组织感染最常见（28%），其次是呼吸道感染（26%）和尿路感染（20%）。SI 的发病率为每 100 人年 8.98 例。阿达木单抗（5.27 例/100 人年）的发生率最低，英夫利昔单抗（34.5 例/100 人年）的发生率最高。有 SI 的患者年龄较大（68 岁 vs 60 岁；P = 0.02），接受 bDMARDs 的时间也较长（6.05 年 vs 4.68 年；P = 0.04）。糖皮质激素联合使用并未显著延长住院时间。合并症的存在并没有显著增加 SI 的风险。
年龄和 bDMARD 使用时间是与 SI 风险增加相关的统计学显著因素。合并症在增加 SI 的发生率方面没有起重要作用。与仅接受 bDMARDs 的患者相比，同时接受糖皮质激素和 bDMARDs 的患者的住院时间没有显著增加。需要在这一领域进行更多的研究，以获得关于合并症在 SI 风险中的作用以及与每种 bDMARD 相关的个体感染风险的统计学显著结论。
