The risk of gastrointestinal perforations in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the BSRBR-RA
Objectives To evaluate the risk of gastrointestinal perforation (GIP) in subjects with rheumatoid arthritis (RA) treated with antitumour necrosis factor (anti-TNF) therapy compared with non-biological disease-modifying antirheumatic drugs (nbDMARDs). Methods Using data from the British Society for R...
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| Veröffentlicht in: | Annals of the rheumatic diseases 2014-01, Vol.73 (1), p.252-255 |
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| creator | Závada, Jakub Lunt, Mark Davies, Rebecca Low, Audrey SL Mercer, Louise K Galloway, James B Watson, Kath D Symmons, Deborah P Hyrich, Kimme L |
| description | Objectives To evaluate the risk of gastrointestinal perforation (GIP) in subjects with rheumatoid arthritis (RA) treated with antitumour necrosis factor (anti-TNF) therapy compared with non-biological disease-modifying antirheumatic drugs (nbDMARDs). Methods Using data from the British Society for Rheumatology Biologics Register, we compared the incidence of GIPs between 11 881 anti-TNF-treated and 3393 nbDMARD-treated RA patients using Cox regression modelling. Hazard ratios (HRs) with confidence intervals (CI) were calculated. Adjustment was made for potential confounders including current steroid use. The study covered the time period between 2001 and 2011. Results There were 42 (upper 20, lower 22) GI perforations: five in the nbDMARD cohort and 37 in the anti-TNF cohort. After adjustment, treatment with TNF antagonists was associated with an HR of 1.6 (95% CI 0.4 to 6.0) for all GIPs, 2.7 (95% CI 0.4 to 18.1) for lower GIPs and 0.9 (95% CI 0.1 to 5.8) for upper GIPs. Current use of steroids was the single most important predictor of GI perforation with an adjusted HR of 2.9 (95% CI 1.5 to 5.4), but this risk was confined to lower GIPs (HR 8.0, 95% CI 2.6 to 24.1). Conclusions We have not found a statistically significant association between anti-TNF treatment and the risk of GIP. |
| doi_str_mv | 10.1136/annrheumdis-2012-203102 |
| format | Article |
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Methods Using data from the British Society for Rheumatology Biologics Register, we compared the incidence of GIPs between 11 881 anti-TNF-treated and 3393 nbDMARD-treated RA patients using Cox regression modelling. Hazard ratios (HRs) with confidence intervals (CI) were calculated. Adjustment was made for potential confounders including current steroid use. The study covered the time period between 2001 and 2011. Results There were 42 (upper 20, lower 22) GI perforations: five in the nbDMARD cohort and 37 in the anti-TNF cohort. After adjustment, treatment with TNF antagonists was associated with an HR of 1.6 (95% CI 0.4 to 6.0) for all GIPs, 2.7 (95% CI 0.4 to 18.1) for lower GIPs and 0.9 (95% CI 0.1 to 5.8) for upper GIPs. Current use of steroids was the single most important predictor of GI perforation with an adjusted HR of 2.9 (95% CI 1.5 to 5.4), but this risk was confined to lower GIPs (HR 8.0, 95% CI 2.6 to 24.1). Conclusions We have not found a statistically significant association between anti-TNF treatment and the risk of GIP.</description><identifier>ISSN: 0003-4967</identifier><identifier>EISSN: 1468-2060</identifier><identifier>DOI: 10.1136/annrheumdis-2012-203102</identifier><identifier>PMID: 23644671</identifier><identifier>CODEN: ARDIAO</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adult ; Aged ; Antirheumatic Agents - administration & dosage ; Antirheumatic Agents - adverse effects ; Arthritis, Rheumatoid - drug therapy ; Arthritis, Rheumatoid - epidemiology ; Data collection ; Drug dosages ; Female ; Humans ; Hypertension ; Immunosuppressive Agents - administration & dosage ; Immunosuppressive Agents - adverse effects ; Incidence ; Intestinal Perforation - epidemiology ; Male ; Middle Aged ; Proportional Hazards Models ; Registries - statistics & numerical data ; Rheumatoid arthritis ; Rheumatology ; Risk Factors ; Steroids ; Stomach Diseases - epidemiology ; Studies ; Tumor Necrosis Factor-alpha - antagonists & inhibitors</subject><ispartof>Annals of the rheumatic diseases, 2014-01, Vol.73 (1), p.252-255</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright: 2014 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b384t-ca3a6077df3acf1dfad695760d1da5599ca18422a56c8eddee9b9007b095b6643</citedby><cites>FETCH-LOGICAL-b384t-ca3a6077df3acf1dfad695760d1da5599ca18422a56c8eddee9b9007b095b6643</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://ard.bmj.com/content/73/1/252.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://ard.bmj.com/content/73/1/252.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3194,23569,27922,27923,77370,77401</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23644671$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Závada, Jakub</creatorcontrib><creatorcontrib>Lunt, Mark</creatorcontrib><creatorcontrib>Davies, Rebecca</creatorcontrib><creatorcontrib>Low, Audrey SL</creatorcontrib><creatorcontrib>Mercer, Louise K</creatorcontrib><creatorcontrib>Galloway, James B</creatorcontrib><creatorcontrib>Watson, Kath D</creatorcontrib><creatorcontrib>Symmons, Deborah P</creatorcontrib><creatorcontrib>Hyrich, Kimme L</creatorcontrib><creatorcontrib>British Society for Rheumatology Biologics Register (BSRBR) Control Centre Consortium</creatorcontrib><creatorcontrib>on behalf of the British Society for Rheumatology Biologics Register (BSRBR) Control Centre Consortium</creatorcontrib><title>The risk of gastrointestinal perforations in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the BSRBR-RA</title><title>Annals of the rheumatic diseases</title><addtitle>Ann Rheum Dis</addtitle><description>Objectives To evaluate the risk of gastrointestinal perforation (GIP) in subjects with rheumatoid arthritis (RA) treated with antitumour necrosis factor (anti-TNF) therapy compared with non-biological disease-modifying antirheumatic drugs (nbDMARDs). Methods Using data from the British Society for Rheumatology Biologics Register, we compared the incidence of GIPs between 11 881 anti-TNF-treated and 3393 nbDMARD-treated RA patients using Cox regression modelling. Hazard ratios (HRs) with confidence intervals (CI) were calculated. Adjustment was made for potential confounders including current steroid use. The study covered the time period between 2001 and 2011. Results There were 42 (upper 20, lower 22) GI perforations: five in the nbDMARD cohort and 37 in the anti-TNF cohort. After adjustment, treatment with TNF antagonists was associated with an HR of 1.6 (95% CI 0.4 to 6.0) for all GIPs, 2.7 (95% CI 0.4 to 18.1) for lower GIPs and 0.9 (95% CI 0.1 to 5.8) for upper GIPs. Current use of steroids was the single most important predictor of GI perforation with an adjusted HR of 2.9 (95% CI 1.5 to 5.4), but this risk was confined to lower GIPs (HR 8.0, 95% CI 2.6 to 24.1). Conclusions We have not found a statistically significant association between anti-TNF treatment and the risk of GIP.</description><subject>Adult</subject><subject>Aged</subject><subject>Antirheumatic Agents - administration & dosage</subject><subject>Antirheumatic Agents - adverse effects</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Arthritis, Rheumatoid - epidemiology</subject><subject>Data collection</subject><subject>Drug dosages</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Immunosuppressive Agents - administration & dosage</subject><subject>Immunosuppressive Agents - adverse effects</subject><subject>Incidence</subject><subject>Intestinal Perforation - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Proportional Hazards Models</subject><subject>Registries - statistics & numerical data</subject><subject>Rheumatoid arthritis</subject><subject>Rheumatology</subject><subject>Risk Factors</subject><subject>Steroids</subject><subject>Stomach Diseases - epidemiology</subject><subject>Studies</subject><subject>Tumor Necrosis Factor-alpha - antagonists & 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treated with anti-TNF therapy: results from the BSRBR-RA</title><author>Závada, Jakub ; Lunt, Mark ; Davies, Rebecca ; Low, Audrey SL ; Mercer, Louise K ; Galloway, James B ; Watson, Kath D ; Symmons, Deborah P ; Hyrich, Kimme L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b384t-ca3a6077df3acf1dfad695760d1da5599ca18422a56c8eddee9b9007b095b6643</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antirheumatic Agents - administration & dosage</topic><topic>Antirheumatic Agents - adverse effects</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Arthritis, Rheumatoid - epidemiology</topic><topic>Data collection</topic><topic>Drug dosages</topic><topic>Female</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Immunosuppressive Agents - administration & dosage</topic><topic>Immunosuppressive Agents - adverse effects</topic><topic>Incidence</topic><topic>Intestinal Perforation - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Proportional Hazards Models</topic><topic>Registries - statistics & numerical data</topic><topic>Rheumatoid arthritis</topic><topic>Rheumatology</topic><topic>Risk Factors</topic><topic>Steroids</topic><topic>Stomach Diseases - epidemiology</topic><topic>Studies</topic><topic>Tumor Necrosis Factor-alpha - antagonists & inhibitors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Závada, Jakub</creatorcontrib><creatorcontrib>Lunt, Mark</creatorcontrib><creatorcontrib>Davies, Rebecca</creatorcontrib><creatorcontrib>Low, Audrey SL</creatorcontrib><creatorcontrib>Mercer, Louise K</creatorcontrib><creatorcontrib>Galloway, James B</creatorcontrib><creatorcontrib>Watson, Kath D</creatorcontrib><creatorcontrib>Symmons, Deborah P</creatorcontrib><creatorcontrib>Hyrich, Kimme L</creatorcontrib><creatorcontrib>British Society for Rheumatology Biologics Register (BSRBR) Control Centre Consortium</creatorcontrib><creatorcontrib>on behalf of the British Society for Rheumatology Biologics Register (BSRBR) Control Centre Consortium</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium 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L</au><aucorp>British Society for Rheumatology Biologics Register (BSRBR) Control Centre Consortium</aucorp><aucorp>on behalf of the British Society for Rheumatology Biologics Register (BSRBR) Control Centre Consortium</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The risk of gastrointestinal perforations in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the BSRBR-RA</atitle><jtitle>Annals of the rheumatic diseases</jtitle><addtitle>Ann Rheum Dis</addtitle><date>2014-01</date><risdate>2014</risdate><volume>73</volume><issue>1</issue><spage>252</spage><epage>255</epage><pages>252-255</pages><issn>0003-4967</issn><eissn>1468-2060</eissn><coden>ARDIAO</coden><abstract>Objectives To evaluate the risk of gastrointestinal perforation (GIP) in subjects with rheumatoid arthritis (RA) treated with antitumour necrosis factor (anti-TNF) therapy compared with non-biological disease-modifying antirheumatic drugs (nbDMARDs). Methods Using data from the British Society for Rheumatology Biologics Register, we compared the incidence of GIPs between 11 881 anti-TNF-treated and 3393 nbDMARD-treated RA patients using Cox regression modelling. Hazard ratios (HRs) with confidence intervals (CI) were calculated. Adjustment was made for potential confounders including current steroid use. The study covered the time period between 2001 and 2011. Results There were 42 (upper 20, lower 22) GI perforations: five in the nbDMARD cohort and 37 in the anti-TNF cohort. After adjustment, treatment with TNF antagonists was associated with an HR of 1.6 (95% CI 0.4 to 6.0) for all GIPs, 2.7 (95% CI 0.4 to 18.1) for lower GIPs and 0.9 (95% CI 0.1 to 5.8) for upper GIPs. Current use of steroids was the single most important predictor of GI perforation with an adjusted HR of 2.9 (95% CI 1.5 to 5.4), but this risk was confined to lower GIPs (HR 8.0, 95% CI 2.6 to 24.1). Conclusions We have not found a statistically significant association between anti-TNF treatment and the risk of GIP.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>23644671</pmid><doi>10.1136/annrheumdis-2012-203102</doi><tpages>4</tpages></addata></record> |
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| ispartof | Annals of the rheumatic diseases, 2014-01, Vol.73 (1), p.252-255 |
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| source | MEDLINE; BMJ Journals - NESLi2 |
| subjects | Adult Aged Antirheumatic Agents - administration & dosage Antirheumatic Agents - adverse effects Arthritis, Rheumatoid - drug therapy Arthritis, Rheumatoid - epidemiology Data collection Drug dosages Female Humans Hypertension Immunosuppressive Agents - administration & dosage Immunosuppressive Agents - adverse effects Incidence Intestinal Perforation - epidemiology Male Middle Aged Proportional Hazards Models Registries - statistics & numerical data Rheumatoid arthritis Rheumatology Risk Factors Steroids Stomach Diseases - epidemiology Studies Tumor Necrosis Factor-alpha - antagonists & inhibitors |
| title | The risk of gastrointestinal perforations in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the BSRBR-RA |
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