Risk of Non-serious Infections in Patients with Rheumatoid Arthritis

Sarfaroj Khan 

Disclosures

April 15, 2021

Takeaway

  • Non-serious infection (NSI) events were common in patients with rheumatoid arthritis (RA), with predictors similar to those for serious infections.

  • Biologics were associated with a greater risk of NSIs, with differences between therapies.

Why this matters

  • Findings will guide clinicians in identifying patients with RA at a greater risk of NSIs and selecting the best possible drug strategies.

Study design

  • The British Society for Rheumatology Biologics Register-Rheumatoid Arthritis (BSRBR-RA) study is a national prospective observational cohort study (n=23,584) initiated in 2001 to monitor the long-term safety of biologics.

  • Primary outcome: NSI reported to the BSRBR-RA by either the clinical team or the patient.

  • Funding: None.

Key results

  • During the 3-year follow-up period, 17,304 NSI episodes were reported in 8145 patients with RA, corresponding to 27.0 (95% CI, 26.6-27.4) NSI events per 100 patient-years of follow-up.

  • The risk of NSIs increased with (adjusted HR [aHR]; 95% CI):

    • age (1.03; 1.01-1.05; P<.01);

    • gender (1.61; 1.51-1.71; P<.001);

    • higher rheumatic disease comorbidity index (1.11; 1.09-1.13; P<.001);

    • steroid therapy (1.25; 1.19-1.32; P<.001); and

    • higher Disease Activity Score 28 (1.15; 1.13-1.18) and Health Assessment Questionnaire-Disability Index score (1.34; 1.29-1.39; P<.001).

  • Compared with tumour necrosis factor inhibitors (TNFis), interleukin-6 inhibitors (aHR, 1.45; 95% CI, 1.29-1.63; P<.001) and rituximab (aHR, 1.28; 95% CI, 1.14-1.45; P<.001) were associated with an increased risk of NSIs.

  • Conventional synthetic disease-modifying anti-rheumatic drugs were associated with a lower risk of NSIs (aHR, 0.64; 95% CI, 0.59-0.70; P<.001).

  • Within the TNFi class, adalimumab vs etanercept was associated with an increased risk of NSIs (aHR, 1.11; 95% CI, 1.05-1.17; P<.001).

Limitations

 

Bechman K, Halai K, Yates M, Norton S, Cope AP, Hyrich KL, Galloway JB. Non-serious infections in patients with rheumatoid arthritis; results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Arthritis Rheumatol. 2021 Apr 12 [Epub ahead of print]. doi: 10.1002/art.41754. PMID: 33844458.  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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