title: The risk of gastrointestinal perforations in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the BSRBR-RA.
abstract: OBJECTIVE
  To evaluate the risk of gastrointestinal perforation (GIP) in subjects with rheumatoid arthritis (RA) treated with antitumour necrosis factor (anti-TNF) therapy compared with non-biological disease-modifying antirheumatic drugs (nbDMARDs).
  
  
  METHODS
  Using data from the British Society for Rheumatology Biologics Register, we compared the incidence of GIPs between 11 881 anti-TNF-treated and 3393 nbDMARD-treated RA patients using Cox regression modelling. Hazard ratios (HRs) with confidence intervals (CI) were calculated. Adjustment was made for potential confounders including current steroid use. The study covered the time period between 2001 and 2011.
  
  
  RESULTS
  There were 42 (upper 20, lower 22) GI perforations: five in the nbDMARD cohort and 37 in the anti-TNF cohort. After adjustment, treatment with TNF antagonists was associated with an HR of 1.6 (95% CI 0.4 to 6.0) for all GIPs, 2.7 (95% CI 0.4 to 18.1) for lower GIPs and 0.9 (95% CI 0.1 to 5.8) for upper GIPs. Current use of steroids was the single most important predictor of GI perforation with an adjusted HR of 2.9 (95% CI 1.5 to 5.4), but this risk was confined to lower GIPs (HR 8.0, 95% CI 2.6 to 24.1).
  
  
  CONCLUSIONS
  We have not found a statistically significant association between anti-TNF treatment and the risk of GIP.
authors: Arthritis Research UK Epidemiology Unit, The University of Manchester, , Manchester, UK.
authors: Jakub
authors: J
authors: Závada
authors: Mark
authors: M
authors: Lunt
authors: Rebecca
authors: R
authors: Davies
authors: Audrey Sl
authors: AS
authors: Low
authors: Louise K
authors: LK
authors: Mercer
authors: James B
authors: JB
authors: Galloway
authors: Kath D
authors: KD
authors: Watson
authors: Deborah P
authors: DP
authors: Symmons
authors: Kimme L
authors: KL
authors: Hyrich
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D013272:Stomach Diseases / Q000453:epidemiology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Anti-TNF; Corticosteroids; DMARDs (synthetic); NSAIDs; Rheumatoid Arthritis