Ten‐year retrospective review of the incidence of serious infections in patients on biologic disease modifying agents for rheumatoid arthritis in three tertiary hospitals in Western Australia

Abstract

Age and duration of bDMARD use were statistically significant factors associated with an increased risk of SI. Co-morbidities did not play a significant role in increasing the incidence of SI. Patients who were on both glucocorticoids and bDMARDs did not have a significant increase in length of stay when compared with patients who were just on bDMARDs. More research is needed in this area with larger numbers to draw statistically significant conclusions regarding the role of co-morbidities in SI risk and the individual infection risk associated with each bDMARD. This article is protected by copyright. All rights reserved.

Risk of Severe Infection among Rheumatoid Arthritis Patients on Biological DMARDs: A Population-Based Cohort Study

“…The results of the multivariable model show that age, Charlson comorbidity index, and concomitant use of corticosteroids were associated with the risk of severe infections. Age is a well-known risk factor for infections [ 22 , 31 , 32 ], thus, raising some concerns about the use of bDMARDs in the elderly. However, the overall effectiveness in patients affected by young-onset and elderly-onset RA (EORA) is similar [ 33 ]; moreover, recent data demonstrate the safety of the treat-to-target strategy also in EORA patients, supporting the use of bDMARDs in the older age groups [ 34 ].…”

Prediction of infection risk in rheumatoid arthritis patients treated with biologics: are we any closer to risk stratification?

“…A number of patient factors have been evaluated in association with infection risk. Consistently, increasing age [8] and comorbidities [9] have been associated with both serious infection and opportunistic infections. In a recent retrospective single-centre study evaluating patients aged more than 65 years commencing a biologic, the most common adverse event leading to treatment discontinuation was infection [10].…”

The Key Comorbidities in Patients with Rheumatoid Arthritis: A Narrative Review

“…In a large meta-analysis of 106 trials published between 1992 and 2014, an increase in the risk of SI was reported for patients treated with standard-or high-dose bDMARDs compared with csDMARDs; however, no increase in risk was noted for patients treated with low-dose bDMARDs [116]. Correspondingly, in a 10-year retrospective review in patients with RA in Western Australia, the mean duration of bDMARD use correlated with a greater risk of SI (p = 0.04) [110]. These conclusions differ from those reported by Richter et al that patients treated with bDMARDs had a significantly lower risk of developing sepsis (OR: 0.6; 95% CI: 0.4-0.8) and had a significantly lower mortality risk than those treated with csDMARDs.…”

“…A number of patient demographics and comorbidities have been shown to be predictive of the observed increased risk of infection in patients with RA [86]. Factors associated with an increased infection risk include male sex [92,93,96], older age [90,93,95,96,110,111], longer RA disease duration [90,93], a history of SIs [88], lower education [90], family income [90], rural residency [88], geographical location [111], poor nutritional status [112] and higher BMI [111]/obesity [92]. Significantly increased infection risks have been described for patients with comorbid conditions including renal dysfunction [93,95,113], pulmonary disease [89], underlying lung disease [93,112] and diabetes [88,92,111].…”

“…Contrastingly, a metaanalysis of 12 observational studies reported a lower incidence of SI in patients receiving etanercept compared with the TNF inhibitors infliximab or adalimumab (relative risk (RR): 0.6; 95% CI: 0.4-1.0; p = 0.04), although the authors noted that heterogeneity between the studies was high and likely due to differences in study designs and clinical features and, therefore, cautioned against drawing conclusions [120]. Data from a 10-year retrospective review demonstrated that the lowest rate of SI was observed in those receiving treatment with adalimumab (5.3/100 person-years) and it was highest with infliximab (34.5/100 person-years) vs. other bDMARDs [110].…”