Abatacept associated with lower serious infection risk than TNF inhibitors
medwireNews: Rheumatoid arthritis (RA) patients who are treated with abatacept have a lower risk for hospitalization due to infection than those given tumor necrosis factor (TNF) inhibitors, findings from a real-world study suggest.
The investigation included 11,248 patients from a US database who initiated abatacept as a first- or second-line biologic agent between 2006 and 2015, and the same number of propensity-matched patients who initiated TNF inhibitor treatment. Patients were aged an average of approximately 55 years, and around 70% had received corticosteroid treatment in the previous year.
Among abatacept-treated patients, 188 hospitalizations due to infection occurred over an average 168 days of follow-up on active treatment, compared with 219 in the TNF inhibitor group during an average 150 days of follow-up.
These findings translate into incidence rates of 37 versus 47 per 1000 person–years, giving a significant 22% lower risk for hospitalized infection among patients given abatacept, the study authors report in Arthritis Care & Research.
Seoyoung Kim and colleagues from Brigham and Women’s Hospital in Boston, Massachusetts, USA, say that this reduced risk “was driven mostly by infliximab.”
Indeed, when the TNF inhibitors were analyzed individually, abatacept-treated patients had a significant 37% reduced risk for serious infection compared with those given infliximab, but there was no significant risk reduction associated with abatacept versus adalimumab or etanercept.
The researchers also assessed the association between treatment type and the risk for specific types of infection, finding that abatacept was associated with a significant 29% lower respiratory infection risk than TNF inhibitors. However, rates of other types of infection – including genitourinary, gastrointestinal, and bone/joint – were comparable among patients in the two treatment groups.
Kim and team explain that “[g]iven similar efficacy between abatacept and TNF [inhibitors] as biologic therapies for treatment of RA, one of the main determinants in choosing between the medications is minimizing the risk of infection.”
Therefore, these findings indicate that “RA patients with specific concerns about infections may benefit from use of abatacept compared to TNF [inhibitors],” they conclude.
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