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    Association between anti-TNF-alpha therapy and interstitial lung disease

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    Authors
    Herrinton, Lisa J.
    Harrold, Leslie R.
    Liu, Liyan
    Raebel, Marsha A.
    Taharka, Ananse
    Winthrop, Kevin L.
    Solomon, Daniel H.
    Curtis, Jeffrey R.
    Lewis, James D.
    Saag, Kenneth G.
    UMass Chan Affiliations
    Department of Orthopedics and Physical Rehabilitation
    Department of Medicine, Division of Rheumatology
    Meyers Primary Care Institute
    Document Type
    Journal Article
    Publication Date
    2013-04-01
    Keywords
    Tumor Necrosis Factor-alpha
    Lung Diseases, Interstitial
    Clinical Epidemiology
    Health Services Research
    Pharmacy and Pharmaceutical Sciences
    Respiratory Tract Diseases
    
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    Link to Full Text
    http://dx.doi.org/10.1002/pds.3409
    Abstract
    BACKGROUND: Anti-tumor necrosis factor-alpha (TNF-alpha) agents have been hypothesized to increase the risk of interstitial lung disease (ILD), including its most severe manifestation, pulmonary fibrosis. METHODS: We conducted a cohort study among autoimmune disease patients who were members of Kaiser Permanente Northern California, 1998-2007. We obtained therapies from pharmacy data and diagnoses of ILD from review of X-ray and computed tomography reports. We compared new users of anti-TNF-alpha agents to new users of non-biologic therapies using Cox proportional hazards analysis to adjust for baseline propensity scores and time-varying use of glucocorticoids. We also made head-to-head comparisons between anti-TNF-alpha agents. RESULTS: Among the 8417 persons included in the analysis, 38 (0.4%) received a diagnostic code for ILD by the end of follow-up, including 23 of 4200 (0.5%) who used anti-TNF-alpha during study follow-up, and 15 of 5423 (0.3%) who used only non-biologic therapies. The age-standardized and gender-standardized incidence rate of ILD, per 100 person-years, was 0.21 [95% confidence interval (CI) 0-0.43] for rheumatoid arthritis and appreciably lower for other autoimmune diseases. Compared with the use of non-biologic therapies, use of anti-TNF-alpha therapy was not associated with a diagnosis of ILD among patients with rheumatoid arthritis (adjusted hazard ratio, 1.03; 95%CI 0.51-2.07), nor did head-to-head comparisons across anti-TNF-alpha agents suggest important differences in risk, although the number of cases available for analysis was limited. CONCLUSION: The study provides evidence that compared with non-biologic therapies, anti-TNF-alpha therapy does not increase the occurrence of ILD among patients with autoimmune diseases and informs research design of future safety studies of ILD. Copyright (c) 2013 John Wiley and Sons, Ltd.
    Source

    Pharmacoepidemiol Drug Saf. 2013 Apr;22(4):394-402. doi: 10.1002/pds.3409. Link to article on publisher's site

    DOI
    10.1002/pds.3409
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/42942
    PubMed ID
    23359391
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1002/pds.3409
    Scopus Count
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    UMass Chan Faculty and Researcher Publications
    Orthopedics and Physical Rehabilitation Publications

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