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Serious infections in rheumatoid arthritis offspring exposed to tumour necrosis factor α inhibitors: cohort study

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Vinet É1,2, De Moura C2, Pineau CA1, Abrahamowicz M1, Curtis JR3, Bernatsky S1,2. Arthritis Rheumatol. 2018 May 17. doi: 10.1002/art.40536. [Epub ahead of print]

Abstract

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1 McGill University Health Center, Montreal, QC, H4A 3J1, Canada.

2 McGill University, Montreal, QC, H3A 0G4, Canada.

3 University of Alabama at Birmingham, Birmingham, AL, 35294, United States.

Abstract

OBJECTIVE: To evaluate the risk of serious infections in rheumatoid arthritis (RA) offspring exposed to tumour necrosis factor α inhibitors (TNFi) in the gestational period compared to unexposed RA offspring, as well as to children from the general population.

METHODS: We used US claim data (2011-2015) to identify 2 989 RA offspring and a randomly selected group of 14 596 control children, matched ≥4:1 for maternal age, year of delivery, and state of residence. We defined TNFi exposure based on ≥1 filled prescription during pregnancy. We ascertained serious infections based on ≥1 hospitalization with infection as a primary diagnosis, ≤12 months of life. We performed multivariable analyses, adjusting for maternal demographics, co-morbidities, pregnancy complications, and drugs.

RESULTS: Among RA offspring, 380 (12.7%) were exposed to TNFi during pregnancy. The percent of serious infections in RA offspring with no TNFi exposure was similar (2.0%, 95% CI 1.5, 2.8) to non-RA offspring (1.9%, 95% CI 1.9, 2.5), while the percent of serious infections in RA offspring with TNFi exposure was 3.2% (95% CI 2.0, 6.8). In multivariable analyses, we were unable to establish an increased risk of serious infections in RA offspring exposed to TNFi versus both non-RA offspring (OR 1.7; 95% CI 0.8, 3.7) and RA offspring unexposed to TNFi (OR 1.4; 95% CI 0.7, 2.8).

CONCLUSIONS: We did not demonstrate a marked excess risk for serious infections in RA offspring exposed to TNFi during pregnancy versus unexposed RA offspring or general population controls.