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Báo cáo y học: "The association between systemic glucocorticoid therapy and the risk of infection in patients with rheumatoid arthritis: systematic review and metaanalyses"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: The association between systemic glucocorticoid therapy and the risk of infection in patients with rheumatoid arthritis: systematic review and metaanalyses. | Dixon et al. Arthritis Research Therapy 2011 13 R139 http arthritis-research.eom content 13 4 R139 RESEARCH ARTICLE Open Access The association between systemic glucocorticoid therapy and the risk of infection in patients with rheumatoid arthritis systematic review and metaanalyses William G Dixon1 2 Samy Suissa2 and Marie Hudson2 Abstract Introduction Infection is a major cause of morbidity and mortality in patients with rheumatoid arthritis RA . The objective of this study was to perform a systematic review and meta-analysis of the effect of glucocorticoid GC therapy on the risk of infection in patients with RA. Methods A systematic review was conducted by using MEDLINE EMBASE CINAHL and the Cochrane Central Register of Controlled Trials database to January 2010 to identify studies among populations of patients with RA that reported a comparison of infection incidence between patients treated with GC therapy and patients not exposed to GC therapy. Results In total 21 randomised controlled trials RCTs and 42 observational studies were included. In the RCTs GC therapy was not associated with a risk of infection relative risk RR 0.97 95 CI 0.69 1.36 . Small numbers of events in the RCTs meant that a clinically important increased or decreased risk could not be ruled out. The observational studies generated a RR of 1.67 1.49 1.87 although significant heterogeneity was present. The increased risk and heterogeneity persisted when analyses were stratified by varying definitions of exposure outcome and adjustment for confounders. A positive dose-response effect was seen. Conclusions Whereas observational studies suggested an increased risk of infection with GC therapy RCTs suggested no increased risk. Inconsistent reporting of safety outcomes in the RCTs as well as marked heterogeneity probable residual confounding and publication bias in the observational studies limits the opportunity for a definitive conclusion. Clinicians should remain vigilant for infection in .