Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment

Timothy Beukelman, Fenglong Xie, Lang Chen, John W. Baddley, Elizabeth Delzell, Carlos G. Grijalva, James D. Lewis, Rita Ouellet-Hellstrom, Nivedita M. Patkar, Kenneth G. Saag, Kevin Winthrop, Jeffrey R. Curtis

Research output: Contribution to journalArticle

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Abstract

Objective To compare the incidence of hospitalized bacterial infections among children with and children without juvenile idiopathic arthritis (JIA) and to examine the effects of selected medications. Methods Using national Medicaid data from 2000 through 2005, we identified a cohort of children with JIA and a comparator cohort of children with attention deficit hyperactivity disorder (ADHD). Exposures to methotrexate (MTX), TNF inhibitors, and oral glucocorticoids (GCs) were determined using pharmacy claims. Patients hospitalized with bacterial infections were identified using coded discharge diagnoses. We calculated adjusted hazard ratios (HRadj) to compare infection incidence rates while adjusting for relevant covariates. Results We identified 8,479 JIA patients with 13,003 person-years of followup; 36% took MTX and 16% took TNF inhibitors. Compared with ADHD patients, JIA patients who were not currently taking MTX or TNF inhibitors had an increased rate of infection (HRadj 2.0 [95% confidence interval (95% CI) 1.5, 2.5]). Among JIA patients not receiving TNF inhibitor therapy, MTX users had a similar rate of infection as those not currently taking MTX (HRadj 1.2 [95% CI 0.9, 1.7]). TNF inhibitor use (irrespective of MTX) resulted in a similar rate of infection as use of MTX without a TNF inhibitor (HRadj 1.2 [95% CI 0.8, 1.8]). Use of high-dose GCs (≥10 mg/day of prednisone or equivalent) increased the rate of infection as compared with no GC use, after adjustment for MTX and TNF inhibitor use (HRadj 3.1 [95% CI 2.0, 4.7]). Conclusion Children with JIA had an increased rate of infection compared to children with ADHD. Among children with JIA, the rate of infection was not increased with MTX or TNF inhibitor use, but was significantly increased with high-dose GC use.

Original languageEnglish (US)
Pages (from-to)2773-2780
Number of pages8
JournalArthritis and Rheumatism
Volume64
Issue number8
DOIs
StatePublished - Aug 2012

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Juvenile Arthritis
Bacterial Infections
Methotrexate
Glucocorticoids
Infection
Attention Deficit Disorder with Hyperactivity
Confidence Intervals
Therapeutics
Incidence
Medicaid
Prednisone

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy
  • Rheumatology
  • Pharmacology (medical)

Cite this

Beukelman, T., Xie, F., Chen, L., Baddley, J. W., Delzell, E., Grijalva, C. G., ... Curtis, J. R. (2012). Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment. Arthritis and Rheumatism, 64(8), 2773-2780. https://doi.org/10.1002/art.34458

Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment. / Beukelman, Timothy; Xie, Fenglong; Chen, Lang; Baddley, John W.; Delzell, Elizabeth; Grijalva, Carlos G.; Lewis, James D.; Ouellet-Hellstrom, Rita; Patkar, Nivedita M.; Saag, Kenneth G.; Winthrop, Kevin; Curtis, Jeffrey R.

In: Arthritis and Rheumatism, Vol. 64, No. 8, 08.2012, p. 2773-2780.

Research output: Contribution to journalArticle

Beukelman, T, Xie, F, Chen, L, Baddley, JW, Delzell, E, Grijalva, CG, Lewis, JD, Ouellet-Hellstrom, R, Patkar, NM, Saag, KG, Winthrop, K & Curtis, JR 2012, 'Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment', Arthritis and Rheumatism, vol. 64, no. 8, pp. 2773-2780. https://doi.org/10.1002/art.34458
Beukelman, Timothy ; Xie, Fenglong ; Chen, Lang ; Baddley, John W. ; Delzell, Elizabeth ; Grijalva, Carlos G. ; Lewis, James D. ; Ouellet-Hellstrom, Rita ; Patkar, Nivedita M. ; Saag, Kenneth G. ; Winthrop, Kevin ; Curtis, Jeffrey R. / Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment. In: Arthritis and Rheumatism. 2012 ; Vol. 64, No. 8. pp. 2773-2780.
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abstract = "Objective To compare the incidence of hospitalized bacterial infections among children with and children without juvenile idiopathic arthritis (JIA) and to examine the effects of selected medications. Methods Using national Medicaid data from 2000 through 2005, we identified a cohort of children with JIA and a comparator cohort of children with attention deficit hyperactivity disorder (ADHD). Exposures to methotrexate (MTX), TNF inhibitors, and oral glucocorticoids (GCs) were determined using pharmacy claims. Patients hospitalized with bacterial infections were identified using coded discharge diagnoses. We calculated adjusted hazard ratios (HRadj) to compare infection incidence rates while adjusting for relevant covariates. Results We identified 8,479 JIA patients with 13,003 person-years of followup; 36{\%} took MTX and 16{\%} took TNF inhibitors. Compared with ADHD patients, JIA patients who were not currently taking MTX or TNF inhibitors had an increased rate of infection (HRadj 2.0 [95{\%} confidence interval (95{\%} CI) 1.5, 2.5]). Among JIA patients not receiving TNF inhibitor therapy, MTX users had a similar rate of infection as those not currently taking MTX (HRadj 1.2 [95{\%} CI 0.9, 1.7]). TNF inhibitor use (irrespective of MTX) resulted in a similar rate of infection as use of MTX without a TNF inhibitor (HRadj 1.2 [95{\%} CI 0.8, 1.8]). Use of high-dose GCs (≥10 mg/day of prednisone or equivalent) increased the rate of infection as compared with no GC use, after adjustment for MTX and TNF inhibitor use (HRadj 3.1 [95{\%} CI 2.0, 4.7]). Conclusion Children with JIA had an increased rate of infection compared to children with ADHD. Among children with JIA, the rate of infection was not increased with MTX or TNF inhibitor use, but was significantly increased with high-dose GC use.",
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T1 - Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment

AU - Beukelman, Timothy

AU - Xie, Fenglong

AU - Chen, Lang

AU - Baddley, John W.

AU - Delzell, Elizabeth

AU - Grijalva, Carlos G.

AU - Lewis, James D.

AU - Ouellet-Hellstrom, Rita

AU - Patkar, Nivedita M.

AU - Saag, Kenneth G.

AU - Winthrop, Kevin

AU - Curtis, Jeffrey R.

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N2 - Objective To compare the incidence of hospitalized bacterial infections among children with and children without juvenile idiopathic arthritis (JIA) and to examine the effects of selected medications. Methods Using national Medicaid data from 2000 through 2005, we identified a cohort of children with JIA and a comparator cohort of children with attention deficit hyperactivity disorder (ADHD). Exposures to methotrexate (MTX), TNF inhibitors, and oral glucocorticoids (GCs) were determined using pharmacy claims. Patients hospitalized with bacterial infections were identified using coded discharge diagnoses. We calculated adjusted hazard ratios (HRadj) to compare infection incidence rates while adjusting for relevant covariates. Results We identified 8,479 JIA patients with 13,003 person-years of followup; 36% took MTX and 16% took TNF inhibitors. Compared with ADHD patients, JIA patients who were not currently taking MTX or TNF inhibitors had an increased rate of infection (HRadj 2.0 [95% confidence interval (95% CI) 1.5, 2.5]). Among JIA patients not receiving TNF inhibitor therapy, MTX users had a similar rate of infection as those not currently taking MTX (HRadj 1.2 [95% CI 0.9, 1.7]). TNF inhibitor use (irrespective of MTX) resulted in a similar rate of infection as use of MTX without a TNF inhibitor (HRadj 1.2 [95% CI 0.8, 1.8]). Use of high-dose GCs (≥10 mg/day of prednisone or equivalent) increased the rate of infection as compared with no GC use, after adjustment for MTX and TNF inhibitor use (HRadj 3.1 [95% CI 2.0, 4.7]). Conclusion Children with JIA had an increased rate of infection compared to children with ADHD. Among children with JIA, the rate of infection was not increased with MTX or TNF inhibitor use, but was significantly increased with high-dose GC use.

AB - Objective To compare the incidence of hospitalized bacterial infections among children with and children without juvenile idiopathic arthritis (JIA) and to examine the effects of selected medications. Methods Using national Medicaid data from 2000 through 2005, we identified a cohort of children with JIA and a comparator cohort of children with attention deficit hyperactivity disorder (ADHD). Exposures to methotrexate (MTX), TNF inhibitors, and oral glucocorticoids (GCs) were determined using pharmacy claims. Patients hospitalized with bacterial infections were identified using coded discharge diagnoses. We calculated adjusted hazard ratios (HRadj) to compare infection incidence rates while adjusting for relevant covariates. Results We identified 8,479 JIA patients with 13,003 person-years of followup; 36% took MTX and 16% took TNF inhibitors. Compared with ADHD patients, JIA patients who were not currently taking MTX or TNF inhibitors had an increased rate of infection (HRadj 2.0 [95% confidence interval (95% CI) 1.5, 2.5]). Among JIA patients not receiving TNF inhibitor therapy, MTX users had a similar rate of infection as those not currently taking MTX (HRadj 1.2 [95% CI 0.9, 1.7]). TNF inhibitor use (irrespective of MTX) resulted in a similar rate of infection as use of MTX without a TNF inhibitor (HRadj 1.2 [95% CI 0.8, 1.8]). Use of high-dose GCs (≥10 mg/day of prednisone or equivalent) increased the rate of infection as compared with no GC use, after adjustment for MTX and TNF inhibitor use (HRadj 3.1 [95% CI 2.0, 4.7]). Conclusion Children with JIA had an increased rate of infection compared to children with ADHD. Among children with JIA, the rate of infection was not increased with MTX or TNF inhibitor use, but was significantly increased with high-dose GC use.

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