The risk of infections with biologic therapies | Arthritis Information
Furst DE et al. – Study reports that all marketed tumor necrosis factor (TNF) inhibitors appear to increase the risk of serious and nonserious infections compared with DMARDs in patients with rheumatoid arthritis (RA). Although suggestive, data for abatacept and rituximab are less definitive and longer periods of patient exposure are needed for further assessment.
Methods
- Aim was to assess the risk of serious and nonserious bacterial and viral infections associated with the use of biologic therapy in RA pts
- Information was derived from PubMed, EMBASE, and the Cochrane clinical trials register up to and including February 2008
Results
- Pts with RA have a heightened risk of infection, including tuberculosis
- Anakinra and TNF inhibitors are associated with an increased risk of infections vs conventional DMARDs, especially early in the course of treatment
- Most common sites of infection are the respiratory tract (including pneumonia), skin and soft tissue, and the urinary tract
- The risk of TB also appears higher with TNF inhibitors
- TNF inhibitors do not appear to increase the risk of reactivating chronic viral infections
- Influenza and pneumococcal vaccinations are generally effective in the face of TNF inhibitors or abatacept
- Risk of infections and serious infections with abatacept and rituximab may be similar to that of the TNF inhibitors
- To date, there have been no reports from clinical trials of increased TB or opportunistic infections with abatacept or rituximab