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Compared with MTX, TNF inhibitor monotherapy, combination therapy did not increase infection risk in JIA
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Compared with methotrexate monotherapy, tumor necrosis factor inhibitor monotherapy or used in combination with methotrexate were not associated with an increased risk for infection in patients with juvenile idiopathic arthritis, according to recently published findings.
“Neither [tumor necrosis factor inhibitor] TNFi monotherapy nor TNFi plus methotrexate combination therapy were associated with an increased risk of infection compared to methotrexate,” Tim Beukelman, MD, MSCE, in the Division of Pediatric Rheumatology at the University of Alabama at Birmingham, told Healio Rheumatology.
Beukelman and colleagues noted a few studies suggest that TNFi increases the rate of infection compared with methotrexate (MTX), while other studies suggest there is no significant difference between the two treatments. To address these conflicting results, the researchers used Medicaid claims data from 2000 through 2010 to compare the incidence of hospitalized infection among children with juvenile idiopathic arthritis (JIA) after treatment with MTX (n= 3,075), TNFi (n = 2,713) or anakinra (n = 247). The primary outcome was a diagnosis of infection. The researchers calculated hazard ratios in order to compare the infection rates among the different treatments.
There was no increased risk for infection associated with TNFi monotherapy vs. MTX (adjusted hazard ratio = 1.19) or with combination therapy vs. MTX (adjusted hazard ratio = 1.23). High-dose oral glucocorticoid use at baseline — defined as at least 10 mg per day of prednisone — was associated with increased risk for infection (adjusted hazard ratio = 2.03) compared with no glucocorticoids. In addition, anakinra was associated with an increased risk for infection compared with MTX (adjusted hazard ratio = 3.53), but not as much as MTX users who had systemic JIA (adjusted hazard ratio = 2.69).
The researchers noted anakinra’s association with increased risk for infection may have been due to residual confounding by the disease phenotype.
“The decision to use TNFi in the typical patient should likely not be influenced by concerns about infection,” Beukelman said. He added, “We need to learn more about the risk of infection associated with systemic JIA, as it appears to be higher than [in] other categories of JIA.” – by Will Offit
Disclosures: Beukelman has received consulting fees from UCB, Genetech/Roche and Novartis. Please see the full study for a list of all other authors’ relevant financial disclosures.
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