medwireNews: Contrary to concerns, withholding treatment with infliximab prior to surgery does not significantly impact infection or mortality risk in older patients with rheumatoid arthritis (RA), shows a study of patients undergoing cardiovascular or serious bowel surgery.
“These results are similar to several studies of orthopaedic procedures, even though the surgeries we examined have higher risks of infection,” write the authors.
“Both the types of surgery and the older age of the cohorts provide a more stringent test of whether continuation of infliximab close to surgery is associated with an increased risk of infection.”
Michael Ward and Abhijit Dasgupta, from the National Institute of Arthritis and Musculoskeletal and Skin Diseases in Bethesda, Maryland, USA, and colleagues assessed US Medicare claims data collected from 1818 infliximab-treated patients with RA who underwent major surgery between 2007 and 2015.
The patients included in the study, who were an average age of 72–75 years, all received infliximab between 1 and 90 days before having their operations. The group included 956 people who had a coronary artery bypass, aortic, or vascular surgery, and 862 who had serious bowel surgery.
Pneumonia, urinary-tract, and surgical-site infections were the most common infections that occurred after surgery, occurring in 7–12%, 9–15%, and 3–19%, respectively, of the surgical groups.
Although most of the patients had an infliximab treatment gap before their surgery, a small percentage (12–14%) were treated with infliximab less than 2 weeks before their operations. As reported in Rheumatology, the timing of treatment with infliximab did not significantly impact how likely it was that patients would develop infections or die in the month after their operations.
This finding was also true in high-risk subgroups of patients. Indeed, in some groups infliximab treatment in the month before surgery was even linked to reduced postoperative infection risk.
Three previous studies have shown an apparent increase in postoperative infections when tumor necrosis factor inhibitor drugs such as infliximab were not withheld before surgery in people with RA, say the researchers. “Given the small numbers, these associations may have been due to chance,” they say.
While they advocate making decisions based on a patient’s specific history, as individual cases may vary, Ward and Dasgupta suggest that discontinuing infliximab treatment before surgery in people with RA may not be necessary. They also suggest that it should not be assumed that any postoperative infection observed in this patient group should be attributed to infliximab treatment.
By Helen Albert
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