ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 49

Dose Relationship Between Oral Glucocorticoids and TNF Inhibitors and the Risk of Hospitalized Infectious Events Among Patients with Rheumatoid Arthritis

Neil Accortt1, Jennifer Schenfeld2 and Mona Trivedi3, 1Amgen, Inc., Thousand Oaks, CA, 2Docs Global, Inc, North Wales, PA, 3Rheumatology, Amgen, Thousand Oaks, CA

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Infection, Rheumatoid arthritis (RA), steroids and tumor necrosis factor (TNF)

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Date: Sunday, November 8, 2015

Title: Epidemiology and Public Health Poster I: Comorbidities and Outcomes of Systemic Inflammatory Diseases

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Patients with rheumatoid arthritis (RA) are at an increased risk for serious hospitalized infectious events (HIEs). Research suggests that tumor necrosis factor alpha inhibitors (TNFi), as well as oral glucocorticoids (GCs) both increase the risk of HIEs.  Limited information is available regarding the contribution toward HIEs when taking into account the dose-level of oral glucocorticoids when used concomitantly among new users of TNFi.

Methods: We conducted a retrospective cohort study using an administrative claims database. Among incident and prevalent adult RA patients newly exposed to TNFi, patients were assigned to 3 fluid study cohorts: no GC exposure; low-dose GC (≤ 7.5 mg); high-dose GC (>7.5 mg). Patients were required to have at least 1 inpatient or outpatient diagnostic claim for RA (ICD-9-CM 714.0) with an accompanying claim for an incident TNFi and at least 6 months of continuous enrollment prior to TNFi initiation and 6 months after.  Patients could be considered exposed to GCs multiple times during follow-up-time and may contribute time to different categories of exposure.  Follow-up continued until disenrollment, HIE, discontinuation of TNFi, end of study (June 30, 2014), or 2 years after the index-date. The primary outcome was incident HIE and was attributed to the GC exposure category at the time of the outcome.  Incidence rates and 95% confidence intervals per 100 person years were estimated for HIEs.

Results: The mean age and sex distribution (% of female) of RA-TNFi patients for the no GC, low-dose GC, and high-dose GC were 53.7 and 77%, 55.1 and 76%, and 55.1 and 74%. The risk of HIEs increased with increasing GC dose, with a higher incremental risk from high dose to low dose than from low dose to no dose (Table). The risk of HIEs is highest among patients ages >65 years of age but the elevated dose-related effects are comparable for those <65 and those > 65.  

Conclusion: We found that both high dose and low dose steroids significantly increase the risk of HIEs.  Although steroid doses under 7.5 mg are often considered to be relatively low risk for infection, physicians should bear in mind that even low dose steroids significantly increase the risk of HIEs among patients newly initiating TNFi therapy.

 

                       Table. Incidence Rates of Hospitalized Infectious Events Among RA-TNFi¥ Patients

 

Glucocorticoid Cohorts

 

None

Low^

High*

 

All Patients

Total patients (n)

39,895

18,294

11,685

Number of HIE Cases

988

341

243

Total Patient-Time (yrs)

24664.84

4771.37

1302.88

IR per 100 pyrs

4.01

7.15

18.65

   (95% CI)

(3.77, 4.26)

(6.45, 7.92)

(16.65, 20.89)

Rate Ratio

   (95% CI)

Ref.

1.78

( 1.58 , 2.02)

4.66

( 4.05, 5.36)

 

Ages < 65

Total patients (n)

34,031

15,185

9,599

Number of HIE Cases

682

196

165

Total Patient-Time (yrs)

20881.49

3703.65

1052.94

IR per 100 pyrs

3.27

5.29

15.67

   (95% CI)

(3.03, 3.51)

(4.60, 6.05)

(13.57, 17.96)

Rate Ratio

   (95% CI)

Ref.

1.62

(1.38 , 1.89)

4.79

(4.05, 5.69)

 

Ages ≥ 65

Total patients (n)

6,103

3,293

2,170

Number of HIE Cases

306

145

78

Total Patient-Time (yrs)

3783.35

1067.72

249.94

IR per 100 pyrs

8.09

13.58

31.21

   (95% CI)

(7.25, 8.99)

(11.62, 15.73)

(25.69, 37.15)

Rate Ratio

   (95% CI)

Ref.

1.68

( 1.38, 2.05)

3.86

(3.00, 4.95)

¥: etanercept, adalimumab, infliximab, golimumab, certolizumab pegol

^: ≤7.5 mg of a prednisone equivalent oral glucocorticoid

*: >7.5 mg of a prednisone equivalent oral glucocorticoid

 

 


Disclosure: N. Accortt, Amgen, 1,Amgen, 1; J. Schenfeld, Amgen, 3; M. Trivedi, Amgen, 1,Amgen, 3.

To cite this abstract in AMA style:

Accortt N, Schenfeld J, Trivedi M. Dose Relationship Between Oral Glucocorticoids and TNF Inhibitors and the Risk of Hospitalized Infectious Events Among Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/dose-relationship-between-oral-glucocorticoids-and-tnf-inhibitors-and-the-risk-of-hospitalized-infectious-events-among-patients-with-rheumatoid-arthritis/. Accessed .
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/dose-relationship-between-oral-glucocorticoids-and-tnf-inhibitors-and-the-risk-of-hospitalized-infectious-events-among-patients-with-rheumatoid-arthritis/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology