medwireNews: Lower disease activity is associated with reduced rates of serious infection among patients with rheumatoid arthritis (RA), and those who achieve sustained remission have the lowest infection risk, results of a registry-based study suggest.
“This finding may motivate patients and healthcare providers to strive for remission rather than only LDA [low disease activity],” write the study authors in Arthritis Care & Research.
Using the Corrona RA registry, Neil Accortt (Amgen Inc, Thousand Oaks, California, USA) and fellow researchers analyzed real-world data from 12,329 RA patients, approximately three-quarters of whom were female, with a mean age of approximately 60 years.
Participants were categorized into three groups according to disease activity measured at two consecutive clinic visits: sustained remission (clinical disease activity index [CDAI]≤2.8); sustained LDA (CDAI>2.8 but ≤10); and sustained moderate-to-high disease activity (MHDA; CDAI>10).
The team found that 2.8% of 3355 patients in the sustained remission group developed a serious infection requiring hospitalization or intravenous antibiotics over a median follow-up of 2.4 years. By comparison, 5.5% of 3912 patients in the LDA group and 5.5% of 5062 patients in the MHDA group experienced serious infections over a median follow-up of 2.5 years and 1.7 years, respectively.
After adjustment for age, sex, and prednisone dose, patients with sustained LDA were significantly more likely to develop a serious infection than those in sustained remission (incidence rate ratio [IRR]=1.69), while those in the sustained MHDA group had a significantly higher infection risk than those with sustained LDA (IRR=1.30).
“Overall, these findings indicate that lower RA disease activity, even between the contrasts of remission and LDA, was associated with a lower risk of serious infections,” say Accortt and colleagues.
They note that although the study was adjusted for potential confounders, residual confounding may have influenced the results, and therefore caution that the “observations reflect associations, but causality should not be inferred.” However, the researchers emphasize that their study represented “a large number of patients in real-world practice.”
And the team concludes: “By contributing to the understanding of the potential safety benefits of achieving remission compared to only attaining LDA, this study may assist clinicians and patients in setting RA treatment goals and deciding how aggressively to strive for remission.”
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