ArticleAnnals of the rheumatic diseases2011
Treatment benefit or survival of the fittest: what drives the time-dependent decrease in serious infection rates under TNF inhibition and what does this imply for the individual patient?
Article in Annals of the rheumatic diseases, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 145 papers, 6 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
145 citing papers in PubMed, 6 syntheses or guidelines pooled it, 359 citations in OpenAlex.
- Pooled it
- [S2e guideline: treatment of rheumatoid arthritis with disease-modifying drugs].Zeitschrift fur Rheumatologie · 2018Guideline
- Systematic review and meta-analysis of serious infections with tofacitinib and biologic disease-modifying antirheumatic drug treatment in rheumatoid arthritis clinical trials.Arthritis research & therapy · 2015Pooled it
- Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis.Lancet (London, England) · 2015Pooled it
- [Recommendations of the German Society for Rheumatology on the perioperative approach under therapy with DMARDs and biologicals in inflammatory rheumatic diseases].Zeitschrift fur Rheumatologie · 2014Guideline
- Including adverse drug events in economic evaluations of anti-tumour necrosis factor-α drugs for adult rheumatoid arthritis: a systematic review of economic decision analytic models.PharmacoEconomics · 2014Pooled it
- Treat-to-target strategies are feasible in elderly-onset rheumatoid arthritis given its reassuring risk-benefit profile.RMD open · 2026Trial
- Efficacy and safety of sarilumab in combination with csDMARDs or as monotherapy in subpopulations of patients with moderately to severely active rheumatoid arthritis in three phase III randomized, controlled studies.Arthritis research & therapy · 2020Trial
- Use of a baseline risk score to identify the risk of serious infectious events in patients with rheumatoid arthritis during certolizumab pegol treatment.Arthritis research & therapy · 2017Trial
- Efficacy and safety of tofacitinib following inadequate response to conventional synthetic or biological disease-modifying antirheumatic drugs.Annals of the rheumatic diseases · 2016Trial
- Head-to-head comparison of the safety of tocilizumab and tumor necrosis factor inhibitors in rheumatoid arthritis patients (RA) in clinical practice: results from the registry of Japanese RA patients on biologics for long-term safety (REAL) registry.Arthritis research & therapy · 2015Trial
- Safety and effectiveness of adalimumab in patients with rheumatoid arthritis over 5 years of therapy in a phase 3b and subsequent postmarketing observational study.Arthritis research & therapy · 2014Trial
- [Clinical characteristics and risk factors of patients with rheumatoid arthritis complicated with urinary tract infection].Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences · 2026Article
- Rare variants in genes related to inborn errors of immunity in patients with rheumatoid arthritis and secondary immunodeficiency.RMD open · 2026Article
- Biologics reduced infections in ankylosing spondylitis and psoriatic arthritis under immunosuppressants.Journal of the Chinese Medical Association : JCMA · 2026Article
- Article
- Risk of pneumonia in individuals with rheumatoid arthritis: a nationwide cohort study.BMJ open respiratory research · 2025Article
- [Septic musculoskeletal complications under immunomodulating treatment].Zeitschrift fur Rheumatologie · 2025Review
- Long-term outcome of a treat-to-target strategy in late-onset rheumatoid arthritis with chronic lung disease: 5-year results of a prospective observational study.Arthritis research & therapy · 2025Observational
- Longitudinal risk of serious infections in patients with inflammatory arthritis on immunomodulating therapy compared to controls.Rheumatology advances in practice · 2025Article
85 more citing papers are in PubMed but not listed here.
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo examine the risk of serious infection conveyed by tumour necrosis factor α (TNFα) inhibitors in the treatment of rheumatoid arthritis (RA).
methodsData from patients with RA enrolled in the German biologics register RABBIT were used for analysis. Baseline patient characteristics, time-varying risk factors (treatment changes, functional capacity) and selection processes caused by dropout, death or switching to non-anti-TNF treatment were taken into account to estimate the adjusted incidence rate ratios (IRR(adj)) of serious infection during treatment with TNF inhibitors compared with non-biological disease-modifying antirheumatic drug treatment.
resultsData were available on 5044 patients, in whom 392 serious infections occurred. The crude rates of serious infections in patients treated with TNF inhibitors declined over the first 3 years of observation (from 4.8 to 2.2/100 patient-years). This decline was driven by (1) treatment termination or loss to follow-up in patients at increased risk and (2) a risk reduction through decreasing glucocorticoid doses and improvement in function. Adjusted for selection processes and time-varying risk factors, the following parameters assessed at baseline (age, chronic diseases) or at follow-up prior to the infection were significantly associated with an increased risk: age >60 years, chronic lung or renal disease, low functional capacity, history of serious infections, treatment with glucocorticoids (7.5-14 mg/day, IRR(adj) 2.1 (95% CI 1.4 to 3.2); ≥ 15 mg/day, IRR(adj) 4.7 (95% CI 2.4 to 9.4)) and treatment with TNFα inhibitors (IRR(adj) 1.8 (95% CI 1.2 to 2.7)).
conclusionReasons for the decline in infection rates observed at the group level were identified. The results enable expected infection rates to be calculated in individual patients based on their risk profiles.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.