Dr Andrade has performed consulting services and received grant support in the past from Merck, Pfizer, and Bristol-Myers Squibb, manufacturers of lipid-lowering drugs.

Objective. To evaluate the risk of serious bacterial infections associated with tumor necrosis factor ␣ (TNF␣) antagonists among rheumatoid arthritis (RA) patients.Methods. A retrospective cohort study of US RA patients enrolled in a large health care organization identified patients who received either TNF␣ antagonists or methotrexate (MTX). Administrative data were used to identify hospitalizations with possible bacterial infections; corresponding medical records were abstracted and reviewed by infectious disease specialists for evidence of definite infections. Proportional hazards models evaluated time-dependent infection risks associated with TNF␣ antagonists.Results. Hospital medical records with claimsidentified suspected bacterial infections were abstracted (n ‫؍‬ 187) among RA patients who received TNF␣ antagonists (n ‫؍‬ 2,393; observation time 3,894 personyears) or MTX (n ‫؍‬ 2,933; 4,846 person-years). Over a median followup time of 17 months, the rate of hospitalization with a confirmed bacterial infection was 2.7% among the patients treated with TNF␣ antagonists compared with 2.0% among the patients treated with MTX only. The multivariable-adjusted hazard ratio (HR) of infection among the patients who received TNF␣ antagonists was 1.9 (95% confidence interval [95% CI] 1.3-2.8) compared with patients who received MTX only. The incidence of infections was highest within 6 months after initiating TNF␣ antagonist therapy (2.9 versus 1.4 infections per 100 person-years; multivariable-adjusted HR 4.2, 95% CI 2.0-8.8).Conclusion. The multivariable-adjusted risk of hospitalization with a physician-confirmed definite bacterial infection was ϳ2-fold higher overall and 4-fold higher in the first 6 months among patients receiving TNF␣ antagonists versus those receiving MTX alone. RA patients were at increased risk of serious infections, irrespective of the method used to define an infectious outcome. Patients and physicians should vigilantly monitor for signs of infection when using TNF␣ antagonists, particularly shortly after treatment initiation.

This prospective, multicenter study confirms that spinal cord stimulation can be an effective therapy for management of chronic low back and extremity pain. Significant improvements in many aspects of the pain condition were measured, and complications were minimal.

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RRV-TV is associated with an increased risk of intussusception. The risk is greatest 3 to 7 days after the first vaccination dose.