J.R. Curtis

Mycobacterial diseases and antitumour necrosis factor therapy in USA

Objective In North America, tuberculosis and nontuberculous mycobacterial (NTM) disease rates associated with antitumour necrosis factor α (anti-TNFα) therapy are unknown. Methods At Kaiser Permanente Northern California, the authors searched automated pharmacy records to identify inflammatory disease patients who received anti-TNF therapy during 2000–2008 and used validated electronic search algorithms to identify NTM and tuberculosis cases occurring during anti-TNF drug exposure. Results Of 8418 anti-TNF users identified, 60% had rheumatoid arthritis (RA). Among anti-TNF users, 18 developed NTM and 16 tuberculosis after drug start. Anti-TNF associated rates of NTM and tuberculosis were 74 (95% CI: 37 to 111) and 49 (95% CI: 18 to 79) per 100 000 person-years, respectively. Rates (per 100, 000 person-years) for NTM and tuberculosis respectively for etanercept were 35 (95% CI: 1 to 69) and 17 (95% CI: 0 to 41); infliximab, 116 (95% CI: 30 to 203) and 83 (95% CI: 10 to 156); and adalimumab, 122 (95% CI: 3 to 241) and 91 (95% CI: 19 to 267). Background rates for NTM and tuberculosis in unexposed RA-patients were 19.2 (14.2 to 25.0) and 8.7 (5.3 to 13.2), and in the general population were 4.1 (95% CI 3.9 to 4.4) and 2.8 (95% CI 2.6 to 3.0) per 100, 000 person-years. Among anti-TNF users, compared with uninfected individuals, NTM case-patients were older (median age 68 vs 50 years, p<0.01) and more likely to have RA (100% vs 60%, p<0.01); whereas, tuberculosis case-patients were more likely to have diabetes (37% vs 16%, p=0.02) or chronic renal disease (25% vs 6%, p=0.02). Conclusions Among anti-TNF users in USA, mycobacterial disease rates are elevated, and NTM is associated with RA.

Medical costs of osteoporosis in the elderly Medicare population

SummaryPrior national cost estimates of osteoporosis and fractures in the USA have been based on diverse sets of provider data or selected commercial insurance claims. Based on a random population-based sample of older adults, the US medical cost of osteoporosis and fractures is estimated at

Estimates of the proportion of older white men who would be recommended for pharmacologic treatment by the new US national osteoporosis foundation guidelines

22 billion in 2008.IntroductionNational cost estimates of osteoporosis and fractures in the USA have been based on diverse sets of provider data or selected commercial insurance claims. We sought to characterize prevalence and costs for osteoporosis using a random population-based sample of older adults.MethodsA cross-sectional estimate of medical cost was made with 2002 data from the Medicare Current Beneficiary Survey (MCBS). MCBS combines health interviews with claims information from all payers to profile a random sample of 12,700 Medicare recipients. Three cohorts aged 65 or over were defined: (1) patients experiencing a fracture-related claim in 2002; (2) patients with a diagnosis, medication, or self-report for osteoporosis or past hip fracture; and (3) non-case controls. The total cost of patient claims was compared to that of controls using multiple regression.ResultsOf 30.2 million elderly Medicare recipients in 2002, 1.6 million (5%) were treated for a fracture that year, and an additional 7.2 million (24%) have osteoporosis without a fracture. The estimated mean impact of fractures on annual medical cost was

THU0131 Tofacitinib (CP-690,550), an oral janus kinase inhibitor: Analysis of malignancies across the rheumatoid arthritis clinical programme

8,600 (95% confidence interval,

SAT0001 Antibody Response to Pneumococcal and Influenza Vaccination in Patients With RA Receiving Subcutaneous Abatacept

6,400 to

SAT0229 Herpes Zoster and Tofacitinib: The Risk of Concomitant Nonbiologic Therapy

10,800), implying a US cost of

OP0154 Integrated Safety Analysis of Tofacitinib in RA Clinical Trials with A Cumulative Exposure of 12,664 Patient-Years

14 billion (

THU0140 Tofacitinib (CP-690,550), an oral janus kinase inhibitor: Analysis of gastrointestinal adverse events across the rheumatoid arthritis clinical programme

10 to

OP0133 Differences in Physician-Reported and DAS28-Based Assessment of Disease Remission Among Patients with Rheumatoid Arthritis (RA) in Clinical Practices

17 billion). Half of the non-fracture osteoporosis patients received drug treatment, averaging

FRI0004 Randomization to Patient-Reported RAPID3 versus Physician-Based CDAI Tools for Prediction of Treatment Response and Assessment of Patient-Reported Outcomes in Rheumatoid Arthritis Patients Receiving Certolizumab Pegol: Results from the PREDICT Study

500 per treated patient, or