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The risk of tuberculosis disease in rheumatoid arthritis patients on biologics and targeted therapy: A 15-year real world experience in Taiwan
The objective of this study is to determine the risk of tuberculosis (TB) disease in biologics users among rheumatoid arthritis (RA) patients in Taiwan from 2000 to 2015. This retrospective cohort study enrolled adult RA patients initiated on first biologics at Taichung Veterans General Hospital. TB...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453436/ https://www.ncbi.nlm.nih.gov/pubmed/28570568 http://dx.doi.org/10.1371/journal.pone.0178035 |
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author | Lim, Chong Hong Chen, Hsin-Hua Chen, Yi-Hsing Chen, Der-Yuan Huang, Wen-Nan Tsai, Jaw-Ji Hsieh, Tsu-Yi Hsieh, Chia-Wei Hung, Wei-Ting Lin, Ching-Tsai Lai, Kuo-Lung Tang, Kuo-Tung Tseng, Chih-Wei Chen, Yi-Ming |
author_facet | Lim, Chong Hong Chen, Hsin-Hua Chen, Yi-Hsing Chen, Der-Yuan Huang, Wen-Nan Tsai, Jaw-Ji Hsieh, Tsu-Yi Hsieh, Chia-Wei Hung, Wei-Ting Lin, Ching-Tsai Lai, Kuo-Lung Tang, Kuo-Tung Tseng, Chih-Wei Chen, Yi-Ming |
author_sort | Lim, Chong Hong |
collection | PubMed |
description | The objective of this study is to determine the risk of tuberculosis (TB) disease in biologics users among rheumatoid arthritis (RA) patients in Taiwan from 2000 to 2015. This retrospective cohort study enrolled adult RA patients initiated on first biologics at Taichung Veterans General Hospital. TB risks were determined as hazard ratio (HR) with 95% confidence interval (CI) using cox regression. A total of 951 patients were recruited; etanercept (n = 443), adalimumab (n = 332), abatacept (n = 74), golimumab (n = 60), tocilizumab (n = 31) and tofacitinib (n = 11). Twenty-four TB cases were identified; 13 in etanercept and 11 in adalimumab group with the TB incidence rate of 889.3/ 100,000 and 1055.6/ 100,000 patient-years respectively. There was no significant difference in TB risk between adalimumab and etanercept users with an incidence rate ratio of 1.27 (p = 0.556 by Poisson model). Significant 2-year TB risk factors included elderly patient >65 year-old (HR: 2.72, 95% CI: 1.06–6.99, p = 0.037), history of TB (HR: 6.24, 95% CI: 1.77–22.00, p = 0.004) and daily glucocorticoid use ≥5mg (HR:5.01, 95% CI: 1.46–17.21, p = 0.010). Sulfasalazine treatment appeared to be protective (HR: 0.32, 95% CI: 0.11–0.97, p = 0.043). Risk management plan (RMP) for TB before initiation of biologics commenced in 2012. The 2-year TB risks after RMP was compared with that before 2012 (HR:0.67, 95% CI: 0.30–1.49, p = 0.323). Elderly RA patients with a history of previous TB infection and concomitant moderate dose glucocorticoid were at higher risk of TB disease. Concurrent sulfasalazine treatment appeared to be a protective factor against TB disease. |
format | Online Article Text |
id | pubmed-5453436 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-54534362017-06-12 The risk of tuberculosis disease in rheumatoid arthritis patients on biologics and targeted therapy: A 15-year real world experience in Taiwan Lim, Chong Hong Chen, Hsin-Hua Chen, Yi-Hsing Chen, Der-Yuan Huang, Wen-Nan Tsai, Jaw-Ji Hsieh, Tsu-Yi Hsieh, Chia-Wei Hung, Wei-Ting Lin, Ching-Tsai Lai, Kuo-Lung Tang, Kuo-Tung Tseng, Chih-Wei Chen, Yi-Ming PLoS One Research Article The objective of this study is to determine the risk of tuberculosis (TB) disease in biologics users among rheumatoid arthritis (RA) patients in Taiwan from 2000 to 2015. This retrospective cohort study enrolled adult RA patients initiated on first biologics at Taichung Veterans General Hospital. TB risks were determined as hazard ratio (HR) with 95% confidence interval (CI) using cox regression. A total of 951 patients were recruited; etanercept (n = 443), adalimumab (n = 332), abatacept (n = 74), golimumab (n = 60), tocilizumab (n = 31) and tofacitinib (n = 11). Twenty-four TB cases were identified; 13 in etanercept and 11 in adalimumab group with the TB incidence rate of 889.3/ 100,000 and 1055.6/ 100,000 patient-years respectively. There was no significant difference in TB risk between adalimumab and etanercept users with an incidence rate ratio of 1.27 (p = 0.556 by Poisson model). Significant 2-year TB risk factors included elderly patient >65 year-old (HR: 2.72, 95% CI: 1.06–6.99, p = 0.037), history of TB (HR: 6.24, 95% CI: 1.77–22.00, p = 0.004) and daily glucocorticoid use ≥5mg (HR:5.01, 95% CI: 1.46–17.21, p = 0.010). Sulfasalazine treatment appeared to be protective (HR: 0.32, 95% CI: 0.11–0.97, p = 0.043). Risk management plan (RMP) for TB before initiation of biologics commenced in 2012. The 2-year TB risks after RMP was compared with that before 2012 (HR:0.67, 95% CI: 0.30–1.49, p = 0.323). Elderly RA patients with a history of previous TB infection and concomitant moderate dose glucocorticoid were at higher risk of TB disease. Concurrent sulfasalazine treatment appeared to be a protective factor against TB disease. Public Library of Science 2017-06-01 /pmc/articles/PMC5453436/ /pubmed/28570568 http://dx.doi.org/10.1371/journal.pone.0178035 Text en © 2017 Lim et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Lim, Chong Hong Chen, Hsin-Hua Chen, Yi-Hsing Chen, Der-Yuan Huang, Wen-Nan Tsai, Jaw-Ji Hsieh, Tsu-Yi Hsieh, Chia-Wei Hung, Wei-Ting Lin, Ching-Tsai Lai, Kuo-Lung Tang, Kuo-Tung Tseng, Chih-Wei Chen, Yi-Ming The risk of tuberculosis disease in rheumatoid arthritis patients on biologics and targeted therapy: A 15-year real world experience in Taiwan |
title | The risk of tuberculosis disease in rheumatoid arthritis patients on biologics and targeted therapy: A 15-year real world experience in Taiwan |
title_full | The risk of tuberculosis disease in rheumatoid arthritis patients on biologics and targeted therapy: A 15-year real world experience in Taiwan |
title_fullStr | The risk of tuberculosis disease in rheumatoid arthritis patients on biologics and targeted therapy: A 15-year real world experience in Taiwan |
title_full_unstemmed | The risk of tuberculosis disease in rheumatoid arthritis patients on biologics and targeted therapy: A 15-year real world experience in Taiwan |
title_short | The risk of tuberculosis disease in rheumatoid arthritis patients on biologics and targeted therapy: A 15-year real world experience in Taiwan |
title_sort | risk of tuberculosis disease in rheumatoid arthritis patients on biologics and targeted therapy: a 15-year real world experience in taiwan |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453436/ https://www.ncbi.nlm.nih.gov/pubmed/28570568 http://dx.doi.org/10.1371/journal.pone.0178035 |
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