Serious infections in patients with rheumatoid arthritis and psoriatic arthritis treated with tumour necrosis factor inhibitors: data from register linkage of the NOR-DMARD study.

To estimate the incidence of serious infections (SIs) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) treated with tumour necrosis factor inhibitor (TNFi), and compare risk of SIs between patients with RA and PsA. We included patients with RA and PsA from the NORwegian-Disease Modifying Anti-Rheumatic Drug registry starting TNFi treatment. Crude incidence rates (IRs) and IR ratio for SIs were calculated. The risk of SIs in patients with RA and PsA was compared using adjusted Cox-regression models. A total of 3169 TNFi treatment courses (RA/PsA: 1778/1391) were identified in 2359 patients. Patients with RA were significantly older with more extensive use of co-medication. The crude IRs for SIs were 4.17 (95% CI 3.52 to 4.95) in patients with RA and 2.16 (95% CI 1.66 to 2.81) in patients with PsA. Compared with the patients with RA, patients with PsA had a lower risk of SIs (HR 0.59, 95% CI 0.41 to 0.85, p=0.004) in complete set analysis. The reduced risk in PsA versus RA remained significant after multiple adjustments and consistent across strata based on age, gender and disease status. Compared with patients with RA, the risk of SIs was significantly lower in patients with PsA during TNFi exposure.

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Competing interests: TU reports personal fees from Lilly, personal fees from Novartis and personal fees from Pfizer, outside the submitted work. TKK reports personal fees from AbbVie, personal fees from Amgen, personal fees from Biogen, personal fees from Celltrion, personal fees from Eli Lilly, personal fees from Egis, personal fees from Evapharma, personal fees from Ewopharma, personal fees from Gilead, personal fees from Hikma, personal fees from Mylan, personal fees from Novartis, personal fees from Novartis, personal fees from Oktal, personal fees from Pfizer, personal fees from Sandoz, personal fees from Sanofi, outside the submitted work. Diakonhjemmet Hospital has received grants from AbbVie, Amgen, BMS, MSD, Novartis, Pfizer and UCB. SAP reports personal fees from Boehringer Ingelheim and personal fees from Novartis, outside the submitted work.