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Continuing RA therapy in perioperative setting did not increase risk of postoperative infection

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WASHINGTON — Continuing disease-modifying antirheumatic disease monotherapy or combination therapy with a tumor necrosis factor inhibitor for rheumatoid arthritis in the perioperative setting did not increase the risk for postoperative infection, according to findings presented at the American College of Rheumatology Annual Meeting.

Hsin-Hsuan Juo, MD, and colleagues evaluated whether the risk of postoperative infection in patients with rheumatoid arthritis (RA) undergoing surgical procedures is increased with disease-modifying antirheumatic drugs (DMARDs) and/or biologic agents compared with patients who cease medications before the procedure. The study included 9,362 surgeries among 5,544 patients with RA accrued from veterans affairs databases. Treatment groups included methotrexate (MTX) alone, hydroxychloroquine (HCQ) alone, leflunomide (LEF) alone and MTX plus tumor necrosis factor-alpha inhibitor (TNFi).

Hsin-Hsuan Juo

Of the 2,601 surgeries from the MTX monotherapy group, the drug was continued in 1,961 surgeries. No association was reported between continued MTX use during surgery and postoperative infection (odds ratio [OR] = 0.79). Similarly, continued MTX use also was not associated with postoperative wound infection (OR = 0.77).

There were 2,102 surgeries in the HCQ monotherapy group, and the drug was continued in 1,946 of those surgical procedures. Continuing the drug failed to demonstrate an association with postoperative infection (OR = 0.93) or wound infection (OR = 0.86).

Among 652 surgeries in patients treated with LEF alone, the drug was continued in 508 procedures. No association was reported between the continuation of LEF and postoperative infection (OR = 0.78) or wound infection (OR = 0.87).

For 386 patients who received MTX plus TNFi, the combination was continued in 196 patients. In 59 patients, MTX was ceased and TNFi was continued, while MTX was continued and TNFi was stopped in 72 procedures. Cessation of both drugs was used as the reference point, according to Juo. Continuation of only MTX (OR = 0.80), only a TNFi (OR = 0.15) or the combination (OR = 0.35) failed to demonstrate any association with postoperative infection, according to the results. Similarly, continuation of MTX (OR = 1.18), only a TNF inhibitor (OR = 0.19) or the combination (OR = 0.38) demonstrated no association with postoperative wound infections.

“We were not able to find a correlation between increased rate of infections and whether they continued medication or not,” Juo said. “There was no difference in those who continued medication and those who did not continue. Therefore, based on our study, we think that discontinuing medication prior to surgery is probably not necessary. For those patients who need urgent surgery, their surgery should not be postponed just because they are on antirheumatic medications.” – by Rob Volansky

Reference:

Juo HH, et al. Abstract #2001. Presented at: The American College of Rheumatology Annual Meeting; Nov. 11-16, 2016. Washington.

Disclosure: Juo reports no relevant financial disclosures.