Table 3:
Predicted risk and risk differences from inverse probability weighted biologic and glucocorticoid analyses in Medicare and MarketScan
| Hospitalized infection | Prosthetic joint infection | Non-urinary hospitalized infection | 30-day readmission | |||||
|---|---|---|---|---|---|---|---|---|
| Predicted risk % (95% CI) | Risk difference % (95% CI) | Predicted 1-year cumulative incidence % (95% CI) | Difference in 1-year cumulative incidence % (95% CI) | Predicted risk % (95% CI) | Risk difference % (95% CI) | Predicted risk % (95% CI) | Risk difference % (95% CI) | |
| Biologics | ||||||||
| Medicare | ||||||||
| Abatacept (n=1369) | 9.32 (7.52, 11.12) | Reference | 2.57 (N/A) | Reference | 6.22 (4.78, 7.66) | Reference | 6.55 (5.02, 8.09) | Reference |
| Adalimumab (n=1284) | 8.16 (6.44, 9.88) | −1.16 (−3.59, 1.27) | 2.12 (1.20, 3.73) | −0.45 (−1.37, 1.16) | 5.16 (3.80, 6.51) | −1.06 (−3.03, 0.90) | 5.87 (4.48, 7.27) | −0.68 (−2.79, 1.44) |
| Etanercept (n=1836) | 9.57 (8.00, 11.14) | 0.25 (−2.12, 2.62) | 2.59 (1.62, 4.12) | 0.02 (−0.95, 1.55) | 6.70 (5.35, 8.05) | 0.48 (−1.49, 2.44) | 6.75 (5.36, 8.14) | 0.20 (−1.87, 2.26) |
| Infliximab (n=2798) | 9.02 (7.79, 10.25) | −0.30 (−2.43, 1.83) | 2.81 (1.74, 4.53) | 0.24 (−0.83, 1.96) | 5.98 (4.92, 7.04) | −0.24 (−2.03, 1.55) | 5.63 (4.59, 6.66) | −0.92 (−2.80, 0.96) |
| Rituximab (n=337) | 10.13 (6.29, 13.98) | 0.81 (−3.43, 5.06) | 0.43 (0.14, 1.35) | −2.14 (−2.44, −1.22)* | 6.22 (3.23, 9.21) | 0.00 (−3.31, 3.32) | 6.71 (3.45, 9.98) | 0.16 (−3.39, 3.71) |
| Tocilizumab (n=305)† | 7.94 (4.55, 11.34) | −0.29 (−4.18, 3.59) | 3.90 (1.72, 8.76) | 1.64 (−0.54, 6.51) | 4.64 (2.34, 6.94) | −1.49 (−4.22, 1.25) | 5.18 (2.65, 7.71) | −1.04 (−4.08, 1.99) |
| MarketScan‡ | ||||||||
| Abatacept (n=395) | 4.47 (2.18, 6.76) | Reference | 1.26 (N/A) | Reference | 2.36 (0.72, 4.01) | Reference | 1.45 (0.37, 2.52) | Reference |
| Adalimumab (n=718) | 3.11 (1.85, 4.36) | −1.36 (−3.98, 1.25) | 1.64 (0.45, 5.95) | 0.38 (−0.81, 4.69) | 2.00 (0.98, 3.02) | −0.36 (−2.30, 1.57) | 2.45 (1.20, 3.70) | 1.00 (−0.65, 2.66) |
| Etanercept (n=1118) | 5.22 (3.86, 6.57) | 0.75 (−1.92, 3.42) | 1.47 (0.41, 5.27) | 0.21 (−0.85, 4.01) | 3.22 (2.16, 4.28) | 0.86 (−1.11, 2.82) | 2.63 (1.52, 3.74) | 1.19 (−0.35, 2.73) |
| Infliximab (n=593) | 5.14 (3.30, 6.98) | 0.67 (−2.27, 3.61) | 2.46 (0.69, 8.68) | 1.20 (−0.57, 7.42) | 3.40 (1.87, 4.94) | 1.04 (−1.21, 3.28) | 2.00 (0.68, 3.31) | 0.55 (−1.15, 2.25) |
| Rituximab (n=86)§ | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Tocilizumab (n=84)§ | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Glucocorticoids | ||||||||
| Medicare|| | ||||||||
| None (n=4389) | 8.10 (7.21, 8.99) | Reference | 2.34 (N/A) | Reference | 5.38 (4.66, 6.10) | Reference | 5.40 (4.66, 6.14) | Reference |
| ≤5mg/day (n=2133) | 9.44 (8.11, 10.76) | 1.33 (−0.20, 2.87) | 2.63 (1.64, 4.22) | 0.29 (−0.70, 1.88) | 6.21 (5.16, 7.27) | 0.83 (−0.40, 2.07) | 6.93 (5.85, 8.01) | 1.53 (0.21, 2.85)* |
| >5–10 mg/day (n=1102) | 10.14 (8.33, 11.95) | 2.04 (0.03, 4.04)* | 2.70 (1.55, 4.72) | 0.36 (−0.80, 2.37) | 7.08 (5.53, 8.63) | 1.70 (−0.01, 3.41) | 6.84 (5.32, 8.35) | 1.43 (−0.25, 3.12) |
| >10mg/day (n=305) | 17.23 (12.28, 22.18) | 9.12 (4.09, 14.16)* | 4.82 (2.40, 9.56) | 2.48 (0.06, 7.22)* | 12.61 (8.06, 17.17) | 7.23 (2.60, 11.86)* | 8.40 (4.86, 11.94) | 3.00 (−0.65, 6.64) |
| MarketScan¶ | ||||||||
| None (n=1834) | 4.48 (3.50, 5.45) | Reference | 1.63 (N/A) | Reference | 2.35 (1.66, 3.04) | Reference | 2.07 (1.39, 2.76) | Reference |
| ≤5mg/day (n=744) | 5.23 (3.55, 6.91) | 0.75 (−1.18, 2.69) | 2.35 (0.63, 9.24) | 0.72 (−1.00, 7.61) | 4.10 (2.57, 5.64) | 1.75 (0.07, 3.44)* | 2.21 (1.04, 3.38) | 0.14 (−1.22, 1.50) |
| >5–10 mg/day (n=298) | 7.02 (3.39, 10.64) | 2.54 (−1.22, 6.30) | 3.38 (0.82, 14.03) | 1.75 (−0.81, 12.40) | 5.79 (2.45, 9.13) | 3.44 (0.03, 6.85)* | 5.23 (2.00, 8.45) | 3.16 (−0.14, 6.45) |
| >10mg/day (n=118) | 3.61 (0.06, 7.15) | −0.87 (−4.56, 2.81) | 1.26 (0.12, 12.10) | −0.37 (−1.51, 10.47) | 2.08 (−0.54, 4.70) | −0.27 (−2.99, 2.46) | 3.82 (0.05, 7.58) | 1.75 (−2.08, 5.58) |
Predicted risk and risk differences for binary outcomes from logistic regression models with inverse probability weighting. Predicted 1-year cumulative incidence of prosthetic joint infection from competing risk regression (Fine and Gray) with death as a competing risk – no confidence interval available for the reference group, which represents the reference cumulative incidence at one year. Odds ratios and subdistribution hazards ratios from these models shown in Appendix Table 7. Imbalanced covariates added to weighted models as noted. Glucocorticoid dose is the average glucocorticoid dose in prednisone equivalents in the 90 days prior to surgery based on prescriptions for oral glucocorticoids
risk difference p < 0.05
Tocilizumab results from separate analysis restricted to 2011–2015; covariates included in 2011–2015 weighted models: methotrexate past 90 days for hospitalized infections and prosthetic joint infection; year for readmission
Covariates included in weighted models: outpatient visits
Rituximab and tocilizumab excluded from MarketScan analyses because of inadequate sample size.
Covariates included in weighted models: opioid use and number outpatient visits for all outcomes
Covariates included in weighted models: current biologic, age, age2, hydroxychloroquine/ leflunomide/ sulfasalazine use, opioid use, outpatient visits, emergency department visits, and antibiotic use past 90 days for all outcomes; number previous biologics and osteonecrosis for hospitalized infections and prosthetic joint infection; region, urban, hypertension, chronic kidney disease for readmission