title: Severe pyogenic infections in patients taking infliximab: a regional cohort study.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rheumatology Department, Dijon Teaching Hospital, Dijon, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Maillard
authors.forename: Paul
authors.initials: P
authors.lastname: Ornetti
authors.forename: Laurent
authors.initials: L
authors.lastname: Grimault
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Ramon
authors.forename: Sylvie Melac
authors.initials: SM
authors.lastname: Ducamp
authors.forename: Tahar
authors.initials: T
authors.lastname: Saidani
authors.forename: Christian
authors.initials: C
authors.lastname: Tavernier
authors.forename: Jean Francis
authors.initials: JF
authors.lastname: Maillefert
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001424:Bacterial Infections / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000188:drug therapy; D013492:Suppuration
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab