Evidence map›Paper›PMID 26567181›Full record

Observational studyAnnals of the rheumatic diseases2016

Impact of treatment with biologic DMARDs on the risk of sepsis or mortality after serious infection in patients with rheumatoid arthritis.

A Richter, J Listing, M Schneider, T Klopsch, A Kapelle, J Kaufmann, A Zink, A Strangfeld

Registry-linked trialOpen access · hybridAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Annals of the rheumatic diseases, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04335071 (CORON-ACT - a Multicenter, Double-blind, Randomized Controlled Phase II Trial on the Efficacy and Safety of Tocilizumab in the Treatment of Coronavirus Induced Disease), which is not on this map. Cited by 53 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 2 pooled it
5.6field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT04335071 phase2terminatednot on this mapstarted 2020, after this paper: background citation

CORON-ACT - a Multicenter, Double-blind, Randomized Controlled Phase II Trial on the Efficacy and Safety of Tocilizumab in the Treatment of Coronavirus Induced Disease (COVID-19)

TypeinterventionalSponsorInsel Gruppe AG, University Hospital BernRan2020 to 2020Enrolled5ConditionsSARS-CoV-2 InfectionArmsTocilizumab (TCZ), Placebo
3 · Its place in the literature

Who cites it

53 citing papers in PubMed, 2 syntheses or guidelines pooled it, 110 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
  5. FPR1-dependent Pro-inflammatory Ccl4Respiratory research · 2025
    Article
  6. Article
  7. Observational
  8. Article
  9. Article
  10. Review
  11. Review
  12. Article
  13. Article
  14. Article
  15. Review
  16. Article
  17. Article
  18. Article
  19. Observational
  20. [Latest findings from the RABBIT register].Zeitschrift fur Rheumatologie · 2022
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

A RichterDepartment of Epidemiology, German Rheumatism Research Centre, Berlin, Germany.
J ListingDepartment of Epidemiology, German Rheumatism Research Centre, Berlin, Germany.
M SchneiderScientific Advisory Board Düsseldorf, Duesseldorf, Germany.
T KlopschNeubrandenburg, Germany.
A KapelleHoyerswerda, Germany.
J KaufmannLudwigsfelde, Germany.
A ZinkDepartment of Epidemiology, German Rheumatism Research Centre, Berlin, Germany Charité University Medicine Berlin.
A StrangfeldDepartment of Epidemiology, German Rheumatism Research Centre, Berlin, Germany.
Charité - Universitätsmedizin Berlin · DEGerman Rheumatism Research Centre · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThis observational cohort study investigated the impact of biological (b) disease-modifying antirheumatic drugs (DMARDs) on the outcomes of serious infections (SIs) in patients with rheumatoid arthritis.

methodsWe investigated outcomes of SIs observed in 947 patients enrolled in the German biologics register RABBIT(Rheumatoid arthritis: observation of biologic therapy). Outcomes were (1) recovery without complication, (2) sepsis following SI (≤30 days), and (3) death after SI without known sepsis (≤90 days). We applied a multinomial generalised estimating equation model for longitudinal data to evaluate the risks of sepsis and death simultaneously.

resultsSepsis within 30 days after SI was reported in 135 out of 947 patients, 85 of these had a fatal outcome. Fifty-three patients died within 90 days after SI without known sepsis. The adjusted risk of developing sepsis increased with age and was higher in patients with chronic renal disease. Compared with conventional synthetic (cs)DMARDs, the risk was significantly lower when patients were exposed to bDMARDs at the time of SI (OR: 0.56, 95% CI 0.38 to 0.81). Risk factors of fatal SI were higher age, use of glucocorticoids at higher doses and heart failure. Patients treated with bDMARDs and those with better physical function had a significantly lower mortality risk.

conclusionsThese results suggest a beneficial effect of bDMARDs on the risk of sepsis after SI and the risk of a fatal outcome. Successful immunosuppression may prevent an unregulated host response to SI, that is, the escalation to sepsis. Further investigation is needed to validate these results.

Indexed as

AdultAgedAge FactorsAntirheumatic AgentsArthritis, RheumatoidBiological ProductsCohort StudiesFemaleFollow-Up StudiesGlucocorticoidsHumansMaleMiddle AgedRisk FactorsSepsisAntirheumatic AgentsBiological ProductsGlucocorticoidsDMARDs (biologic)EpidemiologyInfectionsRheumatoid ArthritisTreatment

Identifiers

PMID26567181
PMCPMC5013078
OpenAlexW2174531956

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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.