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首页> 外文期刊>Rheumatology >Infections during tumour necrosis factor-alpha blocker therapy for rheumatic diseases in daily practice: a systematic retrospective study of 709 patients.
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Infections during tumour necrosis factor-alpha blocker therapy for rheumatic diseases in daily practice: a systematic retrospective study of 709 patients.

机译：日常实践中风湿性疾病的肿瘤坏死因子-α受体阻滞剂治疗期间的感染：709位患者的系统回顾性研究。

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OBJECTIVE: To evaluate the rate of infections in rheumatic patients treated with tumour necrosis factor (TNF)-alpha blockers in daily practice and to determine potential risk factors of infections. METHODS: Systematic retrospective study was conducted in a tertiary-referral centre of all patients receiving at least one TNF-alpha blocker, between 1997 and December 2004. Serious infections were defined as life-threatening, requiring hospitalization or sequelae. The incidence of infections during the first TNF-alpha blocker course was compared with the incidence during the period just before such therapy, in the same patients and a number needed to harm was calculated. Univariate and multivariate analysis between patients who suffered from at least one infection during treatment or not, was conducted in order to determine potential associated risk factors. RESULTS: Among the 709 patients treated with at least one TNF-alpha blocker, 57.7% had rheumatoid arthritis; a total of 275 infectious events in 245 patients (34.5%) were reported during all treatment courses. Among these infections, 47 infections in 44 patients (6.2%) fulfilled the definition of serious infections. The incidence rate of serious infections was 3.4 +/- 38.7 per 100 patient-yrs before TNF-alpha blocker therapy vs 10.5 +/- 86.9 during the first TNF-alpha blocker course (P = 0.03, number needed to harm = 14). The single risk factor picked up by multivariate analysis to explain infections was previous joint surgery [odds ratio (OR) = 2.07, 95% confidence interval (CI) = (1.43-2.98), P < 0.0001] and, if surgery was taken out of the model, the cumulative dose of steroids [OR = 1.28 (1.04-1.59), P = 0.02]. CONCLUSION: The rate of serious infections during TNF-alpha blocker treatment observed in daily practice conditions was much higher than in phase III trials evaluating TNF-alpha blockers. Serious infections are frequent in daily practice and close monitoring is required.
机译：目的：评估日常实践中使用肿瘤坏死因子（TNF）-α受体阻滞剂治疗的风湿病患者的感染率，并确定潜在的感染危险因素。方法：系统回顾性研究是在1997年至2004年12月期间对所有接受至少一种TNF-α阻滞剂治疗的三级转诊中心进行的。严重感染被定义为威胁生命，需要住院或后遗症。在相同的患者中，将第一个TNF-α阻断剂疗程中的感染发生率与治疗前的发生率进行了比较，并计算了伤害所需的数量。为了确定潜在的相关危险因素，对在治疗期间是否患有至少一种感染的患者之间进行了单因素和多因素分析。结果：709名接受至少一种TNF-α阻滞剂治疗的患者中，有57.7％患有类风湿关节炎。在所有治疗过程中，共报告了245例患者中的275例感染事件（34.5％）。在这些感染中，有44位患者（6.2％）中的47位感染符合严重感染的定义。 TNF-α阻断剂治疗之前，每100名患者-年的严重感染发生率为3.4 +/- 38.7，而首个TNF-α阻断剂治疗期间的严重感染发生率为10.5 +/- 86.9（P = 0.03，需要伤害的数字= 14）。通过多因素分析得出的用于解释感染的单一危险因素是先前的关节手术[几率（OR）= 2.07，95％置信区间（CI）=（1.43-2.98），P <0.0001]，以及是否进行了手术在模型中，类固醇的累积剂量[OR = 1.28（1.04-1.59），P = 0.02]。结论：在日常实践中观察到的TNF-α阻断剂治疗期间的严重感染率远高于评估TNF-α阻断剂的III期试验。在日常实践中，严重的感染经常发生，因此需要严密监视。

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