In patients with RA who fail one TNFi, risk of serious infection is similar between rituximab, second TNFi treatment

In patients with rheumatoid arthritis who did not responded to treatment with one previous tumor necrosis factor inhibitor, the 1-year risk of serious infections was similar between those who switch to a second inhibitor and those who switched to rituximab, according to findings.

Researchers assessed patients with rheumatoid arthritis (RA) enrolled in the British Society for Rheumatology Biologics Register and who failed a first tumor necrosis factor inhibitor (TNFi), and later switched either to a second TNFi (n=3,419) or rituximab (RTX; 1,396).

Baseline data were collected either from patients records or from the original registration and were updated with any information acquired between the start of the first TNFi and the start of the second TNFi.

Follow-up data were acquired through questionnaires sent to the patients’ rheumatologist every 6 months for 3 years and annually thereafter, diaries sent to patients every 6 months for 3 years and information on deaths provided by the U.K. National Health Service Information Center.

Researchers followed patients until first serious infection (SI), treatment discontinuation, last recorded follow-up or the end of the first year after changing medications, whichever came first. An infection was considered an SI if it necessitated hospitalization, IV antibiotics or resulted in death. SIs were attributed to the second TNFi if these took place while the patient was received TNFi or within 90 days of the first missed dose. RTX was determined to be the cause of SIs if these took place while the patient was received RTX or within 9 months after the previous infusion.

The TNFi group contributed 2,765 person-years and the RTX group contributed 1,223 person-years. The researchers found 245 patients had at least one SI within the 12 months after treatment. Of these, 4.8% occurred in TNFi group and 5.8% occurred in RTX group. This equaled a crude rate of 59 SI/1,000 person-years for the TNFi group and 66 SI/1,000 person-years for the RTX group. The adjusted HR for SI was 1.
The HR was not considerably affected by adjustment for age and sex or by further adjustment using propensity scores. There was a similar median time to first infection between the two treatment groups.
“Our study found no difference in the risk of SI over the first year of treatment in patients treated with RTX compared with those treated with a second TNFi after discontinuing a first TNFi,” the researchers wrote. “This information should be of value to clinicians and patients when choosing a second biologic in RA.” -by Jennifer Byrne

 

Disclosure: Hydric reports receiving honoraria from Pfizer and AbbVie, and competitive grant funding from Pfizer in the past 3 years.