Jonathan S. Coblyn, MD reviewing Yun H et al. Arthritis Rheumatol 2016 Jan.

In a retrospective study, risks were highest with infliximab, etanercept, and rituximab.

Infection is the most common serious adverse event associated with biologic agents that are used to treat rheumatoid arthritis (RA) patients. However, agents vary in their mechanisms of action on the immune system, and whether they confer different risks for infection is unclear. Using Medicare claims data, researchers retrospectively evaluated 31,801 RA patients who received tumor necrosis factor (TNF) inhibitors (etanercept [Enbrel], infliximab [Remicade], adalimumab [Humira], certolizumab [Cimzia], or golimumab [Simponi]) or drugs with other mechanisms of action (abatacept [Orencia], rituximab [Rituxan], or tocilizumab [Actemra]). To ensure that patients in different drug groups were relatively comparable, the study included only patients who were taking their second biologic agent (because non-TNF drugs are often begun only after treatment with a TNF inhibitor fails). Abatacept was the most commonly prescribed second biologic (in 30% of patients).

During 12 months of follow-up, 2530 infections that required hospitalization occurred. Compared with abatacept (used as the reference standard), infections were significantly more likely to occur with three agents, after adjustment for infection risk scores and other confounders: infliximab (hazard ratio, 1.39), rituximab (HR, 1.36), and etanercept (HR, 1.24).

Citation(s):

Yun H et al. Comparative risk of hospitalized infection associated with biologic agents in rheumatoid arthritis patients enrolled in Medicare. Arthritis Rheumatol 2016 Jan; 68:56.

JWatch