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Higher infection risk seen with biological vs. traditional DMARDs in patients with RA
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A higher risk for certain infections, including tuberculosis, was seen in patients with rheumatoid arthritis taking biologic vs. traditional disease-modifying anti-rheumatic drugs, according to results of a study from Taiwan.
Using ICD-9 codes, researchers retrospectively identified patients included in Taiwan’s National Health Insurance Research Database who had rheumatoid arthritis (RA) diagnosed between Jan. 1, 1999, and Dec. 31, 2009, and were treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs) or traditional DMARDs (tDMARDs). bDMARDs were classified as azathioprine, cyclosporine, gold sodium thiomalate, Plaquenil (hydroxychloroquine, Covis Pharmaceuticals), Arava (leflunomide, Sanofi-Aventis), methotrexate, minocycline, penicillamine D or Azulfidine (sulfasalazine, Pfizer), whereas tDMARDs included Humira (adalimumab, AbbVie), Enbrel (etanercept, Amgen) or Rituxin (rituximab, Regeneron).
Primary study endpoints were patients who had an in-patient serious bacterial infection (SBI), tuberculosis (TB) diagnosis or lymphoma. The individual bDMARDs, adalimumab and etanercept, were also compared.
The researchers matched 7,888 patients treated with tDMARDs and 3,459 patients treated with bDMARDs — including 1,494 patients treated with etanercept and 746 patients treated with adalimumab — for analysis.
Among the 2,150 cases identified, the researchers found 1,711 cases of SBI, 406 cases of TB and 33 cases of lymphoma. Incidence rate ratios for all cases were higher among patients treated with bDMARDs compared with those treated with tDMARDs, with the exception of the incidence of lymphoma.
In their comparison of the individual bDMARDs, the researchers found incidence risk ratios of all cases but lymphoma were higher for patients treated with adalimumab vs. those treated with etanercept.
Disclosure: See the study for a full list of all authors’ relevant financial disclosures.
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