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08-11-2017 | Rheumatoid arthritis | ACR/ARHP 2017 | News

Choice of biologic unlikely to impact post-operative infection risk in RA patients

medwireNews: Patients with rheumatoid arthritis (RA) who are treated with different biologic therapies have a comparable risk for infection after undergoing elective arthroplasty, study results suggest.

However, glucocorticoid use is associated with an increased infection risk, said lead author Michael George (University of Pennsylvania, Philadelphia, USA), who presented the results at the 2017 ACR/ARHP Annual Meeting in San Diego, California, USA.

Using the Medicare database, George and colleagues investigated infection rates in 7195 RA patients who underwent total knee or hip replacement between 2006 and 2014, the majority of whom were treated with infliximab (35.9%), followed by etanercept (23.5%), abatacept (16.7%), and adalimumab (16.3%).

In all, 675 patients were hospitalized with an infection within 30 days of surgery. Urinary infections occurred most frequently, affecting 5.2% of all patients, while 1.3% experienced skin and soft tissue infections, and 1.0% had pneumonia.

Rates of serious infection were comparable between patients treated with different biologics, ranging from 9.7% in patients treated with tumor necrosis factor inhibitors to 10.0% for those given rituximab or tocilizumab.

When infliximab-treated patients were used as the reference group for multivariable analysis, there was no significant difference in the risk for infection across the different treatment groups after adjustment for factors including age, ethnicity, surgery type, and demographics, said George.

Following a question from a member of the audience about why infliximab was chosen as the reference treatment, George explained that infliximab-treated patients comprised the largest group, meaning that covariates could be balanced more easily, and he noted that the choice of reference group was unlikely to have a substantial impact on the results.

The researchers did, however, find that glucocorticoid treatment was associated with a “substantial increase” in the risk for serious infection after surgery. Patients who took glucocorticoids at dose of greater than 10 mg/day had more than twice the risk for infection than those who were not given glucocorticoids, with an adjusted odds ratio of 2.1.

This finding suggests that “limiting glucocorticoid exposure before surgery should be a focus of perioperative management,” George concluded.

By Claire Barnard

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