PMID- 26509071
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20151028
LR  - 20220316
IS  - 2056-5933 (Print)
IS  - 2056-5933 (Electronic)
IS  - 2056-5933 (Linking)
VI  - 1
IP  - 1
DP  - 2015
TI  - Use of corticosteroids in patients with rheumatoid arthritis treated with 
      infliximab: treatment implications based on a real-world Canadian population.
PG  - e000078
LID - 10.1136/rmdopen-2015-000078 [doi]
LID - e000078
AB  - OBJECTIVE: To describe the rate of concomitant oral corticosteroid use at 
      antitumour necrosis factor (TNF) initiation and at disease remission, and to 
      assess its effect on incidence of infection and sustainability of remission among 
      patients with rheumatoid arthritis (RA) treated with infliximab in Canadian 
      routine care. METHODS: Biological naive patients with RA followed in the Biologic 
      Treatment Registry Across Canada (BioTRAC) were included. The time-dependent 
      association between corticosteroid dose (no use, </=5 mg/day, >5 mg/day) and the 
      incidence of first infection, while considering possible confounders, remission 
      sustainability and the incidence of subsequent infections were assessed with Cox 
      regression. RESULTS: 838 patients were included; mean (SD) baseline age and 
      disease duration were 55.6 (13.5) and 10.5 (9.8) years, respectively. After a 
      mean (SD) of 51.3 (43.6) months, the total incidence of adverse events (AEs) and 
      infections were 110.2 and 19.6 per 100 person-years (PY), respectively. In 
      multivariate analysis, the HR (95% CI) for acquiring an infection was 2.48 (1.24 
      to 4.98) with >5 mg/day of corticosteroids versus no corticosteroids. Similarly, 
      </=5 mg/day of corticosteroids was associated with increased hazard for infection 
      (2.12 (0.97 to 4.66)). Despite DAS28 (disease activity score 28) or Clinical 
      Disease Activity Index (CDAI) remission, corticosteroids were continued in 16.4% 
      and 16.7% of cases, respectively. Continued corticosteroid treatment was not 
      associated with sustainability of remission (HRDAS28 (95% CI) 1.40 (0.95 to 
      2.06); HRCDAI 1.19 (0.75 to 1.88)), however, it had a significant impact on 
      development of infection (HRDAS28 (95% CI) 1.78 (1.00 to 3.19); HRCDAI 2.38 (1.14 
      to 4.99)). CONCLUSIONS: Oral corticosteroid treatment was associated with 
      increased risk of development of infection without impacting sustainability of 
      remission. These results support the notion that corticosteroids should be used 
      concomitantly with anti-TNF for the shortest period possible to achieve 
      remission, and then tapered. TRIAL REGISTRATION NUMBER: NCT00741793.
FAU - Haraoui, Boulos
AU  - Haraoui B
AD  - Unite des Maladies Rhumatismales Centre, University de Montreal , Montreal, 
      Quebec , Canada.
FAU - Jovaisas, Algis
AU  - Jovaisas A
AD  - Division of Rheumatology, Department of Medicine , University of Ottawa , Ottawa, 
      Ontario , Canada.
FAU - Bensen, William G
AU  - Bensen WG
AD  - Division of Rheumatology, Department of Medicine , McMaster University , 
      Hamilton, Ontario , Canada.
FAU - Faraawi, Rafat
AU  - Faraawi R
AD  - Division of Rheumatology, Department of Medicine , McMaster University , 
      Hamilton, Ontario , Canada.
FAU - Kelsall, John
AU  - Kelsall J
AD  - The Mary Pack Arthritis Centre , Vancouver, British Columbia , Canada.
FAU - Dixit, Sanjay
AU  - Dixit S
AD  - Division of Rheumatology, Department of Medicine , McMaster University , 
      Hamilton, Ontario , Canada.
FAU - Rodrigues, Jude
AU  - Rodrigues J
AD  - Clinical Research and Arthritis Centre , Windsor, Ontario , Canada.
FAU - Sheriff, Maqbool
AU  - Sheriff M
AD  - Nanaimo Regional General Hospital , Nanaimo, British Columbia , Canada.
FAU - Rampakakis, Emmanouil
AU  - Rampakakis E
AD  - Scientific Affairs, JSS Medical Research , Montreal, Quebec , Canada.
FAU - Sampalis, John S
AU  - Sampalis JS
AD  - Scientific Affairs, JSS Medical Research , Montreal, Quebec , Canada.
FAU - Lehman, Allen J
AU  - Lehman AJ
AD  - Medical Affairs, Janssen Inc. , Toronto, Ontario , Canada.
FAU - Otawa, Susan
AU  - Otawa S
AD  - Medical Affairs, Janssen Inc. , Toronto, Ontario , Canada.
FAU - Nantel, Francois
AU  - Nantel F
AD  - Medical Affairs, Janssen Inc. , Toronto, Ontario , Canada.
FAU - Shawi, May
AU  - Shawi M
AD  - Medical Affairs, Janssen Inc. , Toronto, Ontario , Canada.
LA  - eng
SI  - ClinicalTrials.gov/NCT00741793
PT  - Journal Article
DEP - 20150429
PL  - England
TA  - RMD Open
JT  - RMD open
JID - 101662038
PMC - PMC4612699
OTO - NOTNLM
OT  - Corticosteroids
OT  - DMARDs (biologic)
OT  - Infections
OT  - Rheumatoid Arthritis
OT  - TNF-alpha
EDAT- 2015/10/29 06:00
MHDA- 2015/10/29 06:01
PMCR- 2015/04/29
CRDT- 2015/10/29 06:00
PHST- 2015/01/27 00:00 [received]
PHST- 2015/03/30 00:00 [revised]
PHST- 2015/04/05 00:00 [accepted]
PHST- 2015/10/29 06:00 [entrez]
PHST- 2015/10/29 06:00 [pubmed]
PHST- 2015/10/29 06:01 [medline]
PHST- 2015/04/29 00:00 [pmc-release]
AID - rmdopen-2015-000078 [pii]
AID - 10.1136/rmdopen-2015-000078 [doi]
PST - epublish
SO  - RMD Open. 2015 Apr 29;1(1):e000078. doi: 10.1136/rmdopen-2015-000078. eCollection 
      2015.