Open J Rheumatol Autoimmune Dis. 2012 May;2(2):14-20. doi: 10.4236/ojra.2012.22004.
TNF-.
Open journal of rheumatology and autoimmune diseases
Julia F Simard, Murray A Mittleman, Nancy A Shadick, Elizabeth W Karlson
Affiliations
Affiliations
- Department of Epidemiology, Harvard School of Public Health, Boston, USA ; Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
- Department of Epidemiology, Harvard School of Public Health, Boston, USA.
- Department of Medicine, Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, USA.
PMID: 25019035
PMCID: PMC4089359 DOI: 10.4236/ojra.2012.22004
Abstract
BACKGROUND: Anti-TNF treatment may increase infection risk, although this has been difficult to study because the timing of anti-TNF treatment is driven by disease activity, which may influence infection susceptibility leading to confounding that varies over time. We evaluated the association between anti-TNF initiation in rheumatoid arthritis (RA) patients on disease modifying anti-rheumatic drugs (DMARD) and infection using multiple approaches adjusting for time-varying confounding.
METHODS: 383 anti-TNF-naïve RA patients on ≥1 non-biologic-DMARD at enrollment from the Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS) were followed up to two years. Pooled logistic regressions estimated the association between anti-TNF and infection by including time-varying covariates in the adjusted models and inverse probability treatment weighting (IPTW).
RESULTS: Adjustment for time-varying disease activity and other suspected confounders yielded non-statistically significant positive associations between anti-TNF start and infection regardless of analytic approach (RR
CONCLUSIONS: Incorporating changing clinical status, and treatment indications and consequences, yielded consistently (though not significantly) elevated relative risks of infection associated with anti-TNF initiation. Due to limited statistical power, we cannot draw firm conclusions. However, we have illustrated multiple approaches adjusting for potential time-varying confounding in longitudinal studies and hope to replicate the approaches in larger studies.
Keywords: Anti-TNF; Infection; Inverse Probability Weighting; Rheumatoid Arthritis
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