Risk of serious infections in patients with rheumatoid arthritis treated in routine care with abatacept, rituximab and tocilizumab in Denmark and Sweden

2019 ◽  
Vol 78 (3) ◽  
pp. 320-327 ◽  
Author(s):  
Kathrine Lederballe Grøn ◽  
Elizabeth V Arkema ◽  
Bente Glintborg ◽  
Frank Mehnert ◽  
Mikkel Østergaard ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Routine Care ◽  
Incidence Rates ◽  
Age And Gender ◽  
Reactive Protein ◽  
Relative Risks ◽  
Quality Register ◽  
Inverse Variance ◽  
Serious Infections ◽  
And Gender

ObjectiveTo estimate (1) crude and age-and gender-adjusted incidence rates (IRs) of serious infections (SI) and (2) relative risks (RR) of SI in patients with rheumatoid arthritis (RA) initiating treatment with abatacept, rituximab or tocilizumab in routine care.MethodsThis is an observational cohort study conducted in parallel in Denmark and Sweden including patients with RA in Denmark (DANBIO) and Sweden (Anti-Rheumatic Treatment in Sweden Register/Swedish Rheumatology Quality Register) who started abatacept/rituximab/tocilizumab in 2010–2015. Patients could contribute to more than one treatment course. Incident SI (hospitalisations listing infection) and potential confounders were identified through linkage to national registries. Age- and gender-adjusted IRs of SI per 100 person years and additionally adjusted RRs of SI during 0–12 and 0–24 months since start of treatment were assessed (Poisson regression). Country-specific RRs were pooled using inverse variance weighting.ResultsWe identified 8987 treatment courses (abatacept: 2725; rituximab: 3363; tocilizumab: 2899). At treatment start, rituximab-treated patients were older, had longer disease duration and more previous malignancies; tocilizumab-treated patients had higher C reactive protein. During 0–12 and 0–24 months of follow-up, 456 and 639 SI events were identified, respectively. The following were the age- and gender-adjusted 12-month IRs for abatacept/rituximab/tocilizumab: 7.1/8.1/6.1 for Denmark and 6.0/6.4/4.7 for Sweden. The 24-month IRs were 6.1/7.5/5.2 for Denmark and 5.6/5.8/4.3 for Sweden. Adjusted 12-month RRs for tocilizumab versus rituximab were 0.82 (0.50 to 1.36) for Denmark and 0.76 (0.57 to 1.02) for Sweden, pooled 0.78 (0.61 to 1.01); for abatacept versus rituximab 0.94 (0.55 to 1.60) for Denmark and 0.86 (0.66 to 1.13) for Sweden, pooled 0.88 (0.69 to 1.12); and for abatacept versus tocilizumab 1.15 (0.69 to 1.90) for Denmark and 1.14 (0.83 to 1.55) for Sweden, pooled 1.13 (0.91 to 1.42). The adjusted RRs for 0–24 months were similar.ConclusionFor patients starting abatacept, rituximab or tocilizumab, differences in baseline characteristics were seen. Numerical differences in IR of SI between drugs were observed. RRs seemed to vary with drug (tocilizumab < abatacept < rituximab) but should be interpreted with caution due to few events and risk of residual confounding.

scholarly journals Gender difference in the incidence of shingles

2004 ◽  
Vol 132 (1) ◽  
pp. 1-5 ◽  
Author(s):  
D. M. FLEMING ◽  
K. W. CROSS ◽  
W. A. COBB ◽  
R. S. CHAPMAN
Keyword(s):  
Herpes Simplex ◽  
Age Groups ◽  
Incidence Rates ◽  
Age Group ◽  
Age And Gender ◽  
Relative Risks ◽  
And Gender ◽  
Incident Cases ◽  
Gender Specific ◽  
Practice Network

We investigated age- and gender-specific incidence of shingles reported in a large sentinel practice network monitoring a defined population over the years 1994–2001. In total, 5915 male and 8617 female incident cases were studied. For each age group, we calculated the relative risk of females to males presenting with shingles. Incidence rates of chickenpox and herpes simplex were examined similarly. Shingles incidence was greater in females in each age group (except for 15–24 years). Relative risks (female to male) were greatest in age groups 45–64 years (1·48) and 0–14 years (1·43). There were no gender differences in the incidence of chickenpox except in the 15–24 years age group (female excess): for herpes simplex there were female excesses in all age groups. Gender-specific age-standardized incidence rates of shingles were calculated for each year and showed a consistent female excess in each of the 8 years (average annual excess 28%).

scholarly journals Secular trends in the incidence and prevalence of gout in Denmark from 1995 to 2015: a nationwide register-based study

Rheumatology ◽  
2018 ◽  
Vol 58 (5) ◽  
pp. 836-839 ◽  
Author(s):  
Kristian Zobbe ◽  
Daniel Prieto-Alhambra ◽  
René Cordtz ◽  
Pil Højgaard ◽  
Jens Skøt Hindrup ◽  
...  
Keyword(s):  
Temporal Trends ◽  
Incidence Rates ◽  
Secular Trends ◽  
Annual Incidence Rate ◽  
Danish Population ◽  
Age And Gender ◽  
National Patient Registry ◽  
National Patient ◽  
And Gender ◽  
Gender Specific

Abstract Objective To investigate temporal trends in the incidence and prevalence of gout in the adult Danish population. Methods Using the nationwide Danish National Patient Registry, we calculated the number of incident gout patients (per 100 000 person-years) within each 1 year period from 1995 to 2015 and the prevalence of gout in 2000 and 2015. Further, we calculated age- and gender-specific incidence rates of gout from 1995 to 2015. Results We identified a total of 45 685 incident gout patients (72.9% males) with a mean age of 65 years (s.d. 16) at diagnosis. In both genders, an increase in age-standardized incidence rates was observed from 32.3/100 000 (95% CI 30.7, 33.9) in 1995 to 57.5/100 000 (95% CI 55.6, 59.5) in 2015 (P < 0.001). Similar trends were observed for 8950 cases diagnosed in rheumatology departments. We likewise observed an increase in the prevalence of gout from 0.29% (95% CI 0.29, 0.30) in 2000 to 0.68% (95% CI 0.68, 0.69) in 2015. Conclusions The annual incidence rate of gout increased by almost 80% in Denmark between 1995 and 2015. The prevalence increased by nearly 130% between 2000 and 2015. Reasons for this are unknown but may include an increase in risk factors (e.g. obesity, diabetes mellitus), longer life expectancy and increased awareness of the disease among patients and/or health professionals.

scholarly journals Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244291
Author(s):  
Camilla Bergh ◽  
David Wennergren ◽  
Michael Möller ◽  
Helena Brisby
Keyword(s):  
Catchment Area ◽  
Fracture Incidence ◽  
Care Seeking ◽  
Age And Gender ◽  
Orthopaedic Care ◽  
Quality Register ◽  
Accessible Information ◽  
National Quality ◽  
Fracture Register ◽  
And Gender

Studies on fracture incidence have mostly been based on retrospectively registered data from local hospital databases. The Swedish Fracture Register (SFR) is a national quality register collecting data prospectively on fractures, at the time of care-seeking. In the present study the incidence of all different fractures, regardless of location, in adults’ ≥ 16 years treated at the only care provider for patients with fractures within a catchment area of approximately 550,000 inhabitants, during 2015‒2018 are described. Age, gender, and fracture location (according to AO/OTA classification) was used for the analyses and presentation of fracture incidences. During the 4-year study period, 23,917 individuals sustained 27,169 fractures. The mean age at fracture was 57.9 years (range 16‒105 years) and 64.5% of the fractures occurred in women. The five most common fractures accounted for more than 50% of all fractures: distal radius, proximal femur, ankle, proximal humerus, and metacarpal fractures. Seven fracture incidence distribution groups were created based on age- and gender-specific incidence curves, providing visual and easily accessible information on fracture distribution. This paper reports on incidence of all fracture locations based on prospectively collected data in a quality register. The knowledge on fracture incidence related to age and gender may be of importance for the planning of orthopaedic care, involving both in- and out-patients as well as allocating surgical resources. Further, this might be useful for organizing preventive measures, especially in countries with similar socioeconomic structure and fracture burden.

scholarly journals Increased monohexosylceramide levels in the serum of established rheumatoid arthritis patients

Rheumatology ◽  
2019 ◽  
Vol 59 (8) ◽  
pp. 2085-2089
Author(s):  
Gabriel Miltenberger-Miltenyi ◽  
Ana Rita Cruz-Machado ◽  
Jennifer Saville ◽  
Vasco A Conceição ◽  
Ângelo Calado ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Early Arthritis ◽  
Classification Criteria ◽  
Control Group ◽  
Established Rheumatoid Arthritis ◽  
Regression Analyses ◽  
Lipid Levels ◽  
Age And Gender ◽  
Patient Groups ◽  
And Gender

Abstract Objectives To identify serum sphingolipids that could act as candidate biomarkers in RA. Methods We performed lipidomic analyses in the serum of 82 participants: 19 established RA patients, 18 untreated early RA patients, 13 untreated early arthritis patients not fulfilling the classification criteria for RA, 12 established SpA patients and 20 controls. We compared the lipid levels from the different patient groups with the control group through multiple-regression analyses controlling for age at diagnosis, gender and medication (cDMARDs and corticoids). Results Established RA patients had significantly increased levels of sphingosine, monohexosylceramide and ceramide compared with controls, when controlling for age and gender. Monohexosylceramide levels remained significantly increased when additionally controlling for medication. On the contrary, SpA patients had significantly decreased levels of ceramide, in both analyses. Conclusion We observed a detectable increase in the levels of certain sphingolipids in the serum of established RA patients when compared with controls, in line with previous observations in the synovial fluid. Such findings provide further evidence that sphingolipids may play a key role in the pathophysiology of RA.

Trends in the Incidence of Deep Vein Thrombosis and Pulmonary Embolism: A 35-Year Population-Based Study.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1488-1488 ◽  
Author(s):  
John A. Heit ◽  
Tanya M. Petterson ◽  
Sara A. Farmer ◽  
Kent R. Bailey ◽  
L. Joseph Melton
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Incidence Rates ◽  
Age And Gender ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
And Gender ◽  
Age Adjusted Rates ◽  
Deep Vein ◽  
Age And Sex

Abstract Background: Recent trends in the incidence of venous thromboembolism (VTE), including idiopathic vs. non-idiopathic VTE, have not been well described. Objective: To estimate the incidence of deep vein thrombosis (DVT) and pulmonary embolism with or without DVT (PE), and describe trends in incidence. Methods: Using the resources of the Rochester Epidemiology Project, we identified all Olmsted County, MN residents with an incident DVT and PE over the 35-year period, 1966–2000 (n=3342). For all cases, the complete medical records in the community were reviewed for demographic and baseline characteristics previously identified as risk factors for VTE. Generalized linear models assuming a Poisson error structure, and using a log link function, and a log (population) offset will be used to assess the relationship of crude incidence rates to gender, year of diagnosis and age at diagnosis. Results: The overall average age- and sex-adjusted annual VTE incidence was 122 per 100,000 person-years (DVT, 56 per 100,000; PE, 66 per 100,000), with higher age-adjusted rates among men than women (134 versus 115 per 100,000, respectively). VTE incidence rates increased exponentially with age for both genders, ranging from 4 to 1110 per 100,000 for age groups 0–19 to 90–110 years. Compared to the 5-year period, 1981–85 (when non-invasive diagnostic testing became routinely available), the overall VTE incidence through 2000 remains unchanged. However, the DVT incidence and the PE incidence significantly increased and decreased, respectively, adjusting for age and gender (p<0.001 for both). The overall age- and sex-adjusted annual incidence of idiopathic VTE was 11.7 per 100,000 person-years (DVT, 6.6 per 100,000; PE, 5.1 per 100,000), with age-adjusted rates also higher among men than women (15.1 vs. 9.1 per 100,000). Interestingly, again compared to 1981–85, idiopathic VTE incidence decreased for 1991–95 (p=0.001) and 1996–2000 (p=0.32), adjusting for age and gender. Idiopathic DVT incidence decreased for 1991–95 (p=0.09), and idiopathic PE incidence decreased for both 1991–95 (p=0.004) and 1996–2000 (p=0.03). The overall age- and sex-adjusted annual incidence of non-idiopathic VTE was 109.4 per 100,000 (DVT, 48.4 per 100,000; PE, 60.7 per 100,000), again, with age-adjusted rates higher in men than women (115.1 vs. 106.8 per 100,000). Non-idiopathic DVT incidence increased steadily since 1981–85 (p=0.006, p<0.001, and p<0.001 for increasing DVT incidence for 1986–1990–1991–1995–1996–2000, respectively, adjusting for age and gender). Non-idiopathic PE incidence, however, remained unchanged for 1986–2000. Conclusions: VTE remains a major national health problem, especially among the elderly. Despite improved VTE prophylaxis efficacy and utilization, the overall incidence of VTE remains unchanged. However, the decreasing incidence of idiopathic DVT, and particularly idiopathic PE (with its associated poor survival) raises the possibility that the total number of VTE(PE)-related deaths may also be decreasing, albeit slightly. This hypothesis requires formal testing. The increasing or steady incidence of non-idiopathic DVT and PE, respectively, suggests the need for more widespread, effective VTE prophylaxis.

Racial Differences in Long-Term Risk of Venous Thromboembolism Among Older Patients Following Diagnosis and Treatment of Multiple Myeloma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2071-2071
Author(s):  
Sruthi Adimadhyam ◽  
Karen Sweiss ◽  
Pritesh R. Patel ◽  
Brian C.-H. Chiu ◽  
Gregory S. Calip
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Incidence Rate ◽  
Cell Transplantation ◽  
Lower Incidence ◽  
Incidence Rates ◽  
Age And Gender ◽  
Vte Prophylaxis ◽  
Race Ethnicity ◽  
And Gender

Abstract Introduction Individuals with multiple myeloma (MM) are at a greater risk of thrombotic complications than those with other cancers. Cancer-related venous thromboembolism (VTE) including pulmonary embolism and deep vein thrombosis is associated with increased morbidity and mortality. Both incidence of MM and VTE differ by race/ethnicity. Blacks have a higher incidence of MM compared to Whites, whereas Asian/Pacific Islanders (API) and Hispanics have a lower incidence. In the general population, the risk of VTE and prevalence of its associated risk factors are higher in Blacks. The hypercoagulable state induced by MM and its treatment could further modify any pre-existing VTE risk in different racial/ethnic groups. Our objective was to describe the incidence of VTE following diagnosis and treatment of MM by race/ethnicity. Methods We conducted a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) - Medicare linked database. Individuals 66 years or older with myeloma as their first primary malignancy diagnosed between 2001 - 2011 were identified. These individuals were required to have age related eligibility for Medicare, continuous enrollment in the 12 months period prior and post myeloma diagnosis, and Medicare as their primary payer. Using SEER registries and administrative claims, we collected data on race/ethnicity, cancer characteristics and treatment, and chronic comorbidities. VTE events were defined as having an inpatient hospitalization or 2+ outpatient visits with ICD-9 diagnosis codes 415.1x, 451.xx, and 453.xx. Long-term risk of VTE was assessed by determining the annualized incidence of VTE at 12, 24, and 36 months following MM diagnosis. In each 12-month period, MM patients were followed from diagnosis until the earliest of the following: a VTE event, death, or end of 12-month period since diagnosis. Additionally, we calculated VTE incidence rates in the 12-month period following stem cell transplantation for those that received it. Overall and race-specific crude incidence rates with 95% confidence intervals (CIs) were calculated in each period using person-time contributed per observation period. Poisson regression was used to compare age- and gender-adjusted incidence rate ratios (IRRs) and 95% CIs comparing different racial/ethnic groups with White patients. Results In a final analytic cohort of 9,480 patients, most were White (73%) and fewer patients were Black (15%), Hispanic (6%) or API (4%). The median age at diagnosis was 77 years (interquartile range [IQR]: 71-82). Half the cohort (51%) were women, 28% had diabetes and 21% had a history of heart failure at diagnosis. Overall, the median time to first VTE event post-MM diagnosis was 140 days (IQR: 46-409). More patients that developed VTE were female, Black, younger at MM diagnosis, and treated with stem cell transplantation. The overall incidence rate of VTE during the first 12 months following the diagnosis of MM was 170 per 1,000 person-years (95% CI 160-180). Adjusting for age and gender, Blacks had a higher incidence of VTE compared to Whites (IRR 1.24; 95% CI 1.07-1.44) and APIs had a lower incidence (IRR 0.55; 95% CI 0.37-0.81). In the second post-diagnosis year, there were 6,257 individuals remaining that contributed 5,443 person-years. Overall, the incidence rate was 82 per 1,000 person-years (95% CI 75-90). Incidence was greater in Blacks vs. Whites (adjusted IRR 1.25; 95% CI 0.98-1.59). Consistent with findings from the first analysis period, APIs continued to have lower incidence vs. Whites (adjusted IRR 0.44; 95% CI 0.22-0.89). In the third post-diagnosis year, the overall incidence rate was 80 per 1,000 person-years (95% CI 72-89) and any racial disparities observed in age and gender adjusted IRRs were no longer significant. For patients in the first year following stem cell transplantation, annualized incidence rates of VTE were elevated (overall incidence rate of 148, 95% CI 117-188). Conclusion In this large population-based cohort of older MM patients, we observed racial disparities in the incidence of VTE within the first 24 months of diagnosis. A risk-adapted method of VTE prophylaxis should be considered. Understanding risk factors and groups vulnerable to development of thromboembolic events can help guide clinical decision making regarding VTE prophylaxis. Disclosures No relevant conflicts of interest to declare.

Overall infection risk in rheumatoid arthritis during treatment with abatacept, rituximab and tocilizumab; an observational cohort study

Rheumatology ◽  
2019 ◽  
Vol 59 (8) ◽  
pp. 1949-1956 ◽  
Author(s):  
Kathrine L Grøn ◽  
Bente Glintborg ◽  
Mette Nørgaard ◽  
Frank Mehnert ◽  
Mikkel Østergaard ◽  
...  
Keyword(s):  
Cohort Study ◽  
Relative Risk ◽  
Routine Care ◽  
Incidence Rates ◽  
Observational Cohort Study ◽  
Tnf Inhibitor ◽  
Observational Cohort ◽  
Never Smokers ◽  
And Gender ◽  
Rate Ratios

Abstract Objectives Most infections in patients with RA are treated in primary care with antibiotics. A small fraction require hospitalization. Only a few studies exist regarding the overall risk of infection (i.e. prescription of antibiotics or hospitalization due to infection) in patients initiating non-TNF-inhibitor therapy. In Danish RA patients initiating abatacept, rituximab and tocilizumab treatment in routine care, the aims were to compare adjusted incidence rates (IR) of infections and to estimate relative risk of infections across the drugs during 0–12 and 0–24 months. Methods This was an observational cohort study including all RA patients in the DANBIO registry starting a non-TNF-inhibitor from 2010 to 2017. Infections were defined as a prescription of antibiotics or hospitalization due to infection. Prescriptions, comorbidities and infections were captured through linkage to national registries. IRs of infections (age, gender adjusted) and rate ratios (as estimates of RR (relative risk)), adjusted for additional covariates) (Poisson regression) were calculated. Results We identified 3696 treatment episodes (abatacept 1115, rituximab 1017, tocilizumab 1564). At baseline, rituximab users were older and had more previous cancer. During 0–12 months, 1747 infections occurred. Age and gender-adjusted IRs per 100 person-years were as follows: abatacept: 76 (95% CI: 69, 84); rituximab: 87 (95% CI: 79, 96); tocilizumab: 77 (95% CI: 71, 84). Adjusted RRs were 0.94 (95% CI: 0.81, 1.08) for abatacept and 0.94 (95% CI: 0.81, 1.03) for tocilizumab compared with rituximab and 1.00 (95% CI: 0.88, 1.14) for abatacept compared with tocilizumab. RRs around 1 were observed after 24 months. Switchers and ever smokers had higher risk compared with biologic-naïve and never smokers, respectively. Conclusion Overall infections were common in non-TNF-inhibitor-treated RA patients, with a tendency towards rituximab having the highest risk, but CIs were wide in all analyses. Confounding by indication may at least partly explain any differences.

scholarly journals Serious infections in patients with rheumatoid arthritis and psoriatic arthritis treated with tumour necrosis factor inhibitors: data from register linkage of the NOR-DMARD study

2021 ◽  
pp. annrheumdis-2021-221007
Author(s):  
Ingrid Egeland Christensen ◽  
Siri Lillegraven ◽  
Pawel Mielnik ◽  
Gunnstein Bakland ◽  
Liz Loli ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Tumour Necrosis Factor ◽  
Tumour Necrosis ◽  
Cox Regression ◽  
Disease Status ◽  
Incidence Rates ◽  
Serious Infections ◽  
Factor Inhibitor ◽  
Necrosis Factor

ObjectivesTo estimate the incidence of serious infections (SIs) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) treated with tumour necrosis factor inhibitor (TNFi), and compare risk of SIs between patients with RA and PsA.MethodsWe included patients with RA and PsA from the NORwegian-Disease Modifying Anti-Rheumatic Drug registry starting TNFi treatment. Crude incidence rates (IRs) and IR ratio for SIs were calculated. The risk of SIs in patients with RA and PsA was compared using adjusted Cox-regression models.ResultsA total of 3169 TNFi treatment courses (RA/PsA: 1778/1391) were identified in 2359 patients. Patients with RA were significantly older with more extensive use of co-medication. The crude IRs for SIs were 4.17 (95% CI 3.52 to 4.95) in patients with RA and 2.16 (95% CI 1.66 to 2.81) in patients with PsA. Compared with the patients with RA, patients with PsA had a lower risk of SIs (HR 0.59, 95% CI 0.41 to 0.85, p=0.004) in complete set analysis. The reduced risk in PsA versus RA remained significant after multiple adjustments and consistent across strata based on age, gender and disease status.ConclusionsCompared with patients with RA, the risk of SIs was significantly lower in patients with PsA during TNFi exposure.

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