接受Tofacitinib治療之類風濕性關節炎與乾癬性關節炎患者的尋常性與伺機性感染發生率：台灣回溯性世代研究

Incidence of Common and Opportunistic Infections in Patients with Rheumatoid Arthritis and Psoriatic Arthritis Treated with Tofacitinib: A Retrospective Cohort Study in Taiwan

目的：本研究旨在調查接受tofacitinib治療的類風濕性關節炎及乾癬性關節炎患者中，在台灣發生尋常性感染與伺機性感染的發生率與臨床特徵，特別是隱球菌感染。
方法：本回溯性世代研究分析了自2013年12月1日至2023年11月30日期間，在台灣南部某區域醫院接受tofacitinib治療的患者。納入標準為符合類風濕性關節炎或乾癬性關節炎診斷標準，且持續使用tofacitinib治療超過三個月。系統性回顧感染相關不良事件，並計算每百人年（100 person-years）感染發生率。
結果：本研究共納入154位患者，平均追蹤時間為3.45年。最常見的感染事件為帶狀皰疹，發生率為每百人年3.58±0.82，其次為尿路感染（每百人年1.32±0.50）及軟組織感染（每百人年1.13±0.46）。共發現三例隱球菌感染（每百人年0.56±0.33），較以往其他免疫抑制治療報告所出現隱球菌感染的發生率為高。所有隱球菌感染案例均發生於同時使用皮質類固醇的年長女性。
結論：在接受tofacitinib治療患者中，帶狀皰疹為最常見的伺機性感染。雖然隱球菌感染發生率較低，但相比其他免疫抑制劑的既往報告，其發生率仍偏高。這些結果顯示，在接受免疫治療的患者中，尤其是同時使用類固醇的年長女性，需特別注意監測伺機性感染。

Objective: To investigate the incidence and clinical characteristics of common and opportunistic infections, particularly cryptococcal infection, in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) receiving tofacitinib therapy in Taiwan.
Methods: This retrospective cohort study included patients treated with tofacitinib at a regional hospital in southern Taiwan between December 1, 2013 and November 30, 2023. Patients diagnosed with RA or PsA who had received tofacitinib for more than three months were eligible. Infection events were identified through systematic medical record review, and IRs were calculated per 100 person-years.
Results: A total of 154 patients were enrolled, with a mean follow-up of 3.45 years. The most common infection was herpes zoster (HZ) (IR 3.58±0.82 per 100 person-years), followed by UTI (IR 1.32±0.50 per 100 person-years) and soft tissue infections (IR 1.13±0.46 per 100 person-years). Cryptococcal infections were identified in three patients (IR 0.56±0.33 per 100 person-years), which is higher than rates previously reported with other immunosuppressive agents. All cryptococcal cases occurred in older women concurrently receiving corticosteroids.
Conclusion: HZ was the most common opportunistic infection among patients undergoing tofacitinib therapy. Although cryptococcosis was infrequent, its incidence rate was elevated relative to prior reports on other immunosuppressants. These findings demonstrate the importance of close monitoring for opportunistic infections, particularly in older female patients receiving concomitant corticosteroids.