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Joint Bone Spine
Volume 72, n° 4
pages 330-334 (juillet 2005)
Doi : 10.1016/j.jbspin.2004.09.003
Received : 15 June 2004 ;  accepted : 4 September 2004
Severe pyogenic infections in patients taking infliximab : A regional cohort study

Hélène Maillard a, Paul Ornetti a, Laurent Grimault b, Jean-François Ramon c, Sylvie Melac Ducamp d, Tahar Saidani e, Christian Tavernier a, Jean Francis Maillefert f,
a Rheumatology Department, Dijon Teaching Hospital, Dijon, France 
b Rheumatology Department, Mâcon Hospital Center, Mâcon, France 
c Medicine Department, Avallon Hospital Center, Avallon, France 
d Medicine Department, Nevers Hospital Center, Nevers, France 
e Medicine Department IV, Auxerre Hospital Department, Auxerre, France 
f Inserm/ERIT-M 0207, Bourgogne University, Bourgogne, France 

*Corresponding author. Service de Rhumatologie, Hôpital Général, 3, rue du Fb Raines, 21000 Dijon, France. Tél. : +33-380-29-3745; Fax : +33-380-29-3678.

Objective. - To evaluate the prevalence and risk factors of severe pyogenic infections in rheumatology patients taking infliximab in everyday practice.

Methods. - Regional prospective cohort study of patients taking infliximab for rheumatoid arthritis or ankylosing spondylitis with data collection on standardized forms. The medical records of patients with severe pyogenic infections were subjected to a detailed retrospective review. Patients with and without severe pyogenic infections were compared.

Results. - The cohort included 83 patients (55 women and 28 men). Severe pyogenic infections occurred in five (6%) patients (three women and two men), all of whom had acute or underlying risk factors. Higher values were found in these five patients for mean age (65.8 ± 12 vs. 53.9 ± 13 years, P = 0.04) and mean daily glucocorticoid dosage (15.5 ± 9 vs. 6.9 ± 7 mg/day prednisone-equivalent, P = 0.036), as compared to the other patients.

Conclusion. - Older age and high-dose glucocorticoid therapy are associated with an increased risk of severe pyogenic infection during infliximab therapy. Caution is in order when starting and monitoring infliximab therapy in patients with risk factors. Our data also emphasize the need for a careful search for risk factors before each infliximab infusion.

The full text of this article is available in PDF format.

Keywords : Anti-TNF, Rheumatoid arthritis, Ankylosing spondylitis, Side effects, Pyogenic infections

1  Since the article was written, an update of the British Society for Rheumatology [28] states that "there may be higher levels of mortality in patients with pulmonary fibrosis treated with infliximab.... increased mortality in patients with pulmonary fibrosis could occur with other biologics agents. Until further information is available, caution is needed when exposing RA patients with pulmonary fibrosis to anti-NFalpha drugs. Such patients should be monitored closely for infection and any deterioration in pulmonary function.

© 2004  Elsevier SAS. All Rights Reserved.
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