Serious infection risk similar among non-TNF inhibitor biologics in RA
medwireNews: Study findings do not support the use of one non-tumor necrosis factor (TNF) inhibitor biologic DMARD over another when considering the risk for serious infection in patients with rheumatoid arthritis (RA).
The observational study included 6648 patients with RA from Denmark and Sweden who started 8987 treatment courses with abatacept (n=2725), rituximab (n=3363), or tocilizumab (n=2899) during 2010–2015.
In both countries, rituximab use was more common in older patients, and in those with longer disease duration or a history of malignancy, whereas tocilizumab use was more common in patients with a higher baseline C-reactive protein level.
During the first 12 months of treatment, there were 456 cases of serious infection, defined as hospitalization with a primary diagnosis of infection, with risks highest during the first 6 months of treatment.
The highest rate of infection occurred among patients receiving rituximab in both Denmark and Sweden, with age- and sex-adjusted incidence rates of 8.1 and 6.4 cases per 100 person–years, respectively.
This was followed by abatacept, at 7.1 and 6.0 cases per 100 person–years, respectively, and lastly tocilizumab, at a corresponding 6.1 and 4.7 cases per 100 person–years.
By 24 months, 639 serious infections had occurred, with respective incidence rates in Denmark and Sweden of 7.5 and 5.8 cases per 100 person–years for rituximab, 6.1 and 5.6 cases per 100 person–years with abatacept, and 5.2 and 4.3 cases per 100 person–years with tocilizumab.
A pooled analysis of data from both countries indicated that the relative risk for infection at 12 months was 22% lower with tocilizumab and 12% lower with abatacept than with rituximab, and 13% higher with abatacept versus tocilizumab, after adjustment for multiple potential confounders.
However, Kathrine Lederballe Grøn (University of Copenhagen, Denmark) and co-researchers caution that none of the comparisons reached statistical significance, and that their “findings should be interpreted with caution due to the few events and the risk of residual confounding.”
They conclude in the Annals of the Rheumatic Diseases that the data “do not support that one non-TNF [inhibitor] should be recommended over the other for patients with RA at high risk of [serious infections].”
By Laura Cowen
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