Title: Treatment for Rheumatoid Arthritis and the Risk of Pneumonia
1Treatment for Rheumatoid Arthritis and the Risk
of Pneumonia
- Fred Wolfe1, Kaleb Michaud1 and Liron Caplan2
- 1National Data Bank for Rheumatic Disease
- 2Washington University School of Medicine
2Pneumonia and RA
- Leading cause of hospitalization in US
- Major death cause in RA
- Most reports about drug reactions, opportunistic
infections, RA lung - No prevalence or risk factor studies in RA
- Worry about Rx harm
3Study Aims
- Incidence rate for pneumonia
- Prevalence rate for pneumonia
- Risk factors for pneumonia
- Do RA treatments cause pneumonia?
- Which treatments?
- To what extent?
4Methods - NDB
- 15,979 RA participants
- Long-term outcome study of RA
- 31,586 patient-years
- Semiannual assessment for up to 4 years
- Pneumonia
- ICD-9 codes of 480-486
- Diagnosis validation by hospital, physician, and
death records
5Statistical Methods
- Univariate and multivariable Cox proportional
hazards regression - 5-fold multiple imputation to utilize all data
- Sensitivity analyses
- Removal of subjects with pre-existing lung disease
6Results
7Patient Characteristics - I
8Patient Characteristics - II
9Patient Characteristics - III
10Incidence of Pneumonia in RA
11Incidence of Pneumonia in RA
12Increased Prevalence of Pneumonia in RA vs. NHDS
13Univariate Hazard Ratios for Pneumonia
Hospitalization - I
14Univariate Hazard Ratios for Pneumonia
Hospitalization - II
15Multivariable Hazard Ratios for Pneumonia
Hospitalization - I
16Multivariable Hazard Ratios for Pneumonia
Hospitalization - II
17Multivariable Hazard Ratios for Pneumonia
Hospitalization - III
18Summary Risk of Pneumonia
- Increased in RA
- Risk increased by Prednisone, infliximab and
leflunomide - No MTX association
- CV, lung and diabetes increase risk
- HAQ increases risk
19Support
- Pneumonia incidence rate study supported by a
grant from Bristol-Meyers-Squibb - The NDB has received support from Centocor,
Aventis, Pfizer, Merck, Amgen, Abbott and Wyeth