Serious infection-related hospitalizations drop for PsA despite uptick in biologic use
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Hospitalizations for sepsis, skin and soft tissue infections and UTI among patients with psoriatic arthritis “significantly” decreased over a 5-year period despite a rising uptake in biologics, according to data presented at ACR Convergence 2021.
“One of the biggest questions that we have, as treating rheumatologists, is how do drugs that suppress the immune system translate to the real world with regards to risk of infection?” Vagishwari Murugesan, MD, clinical fellow physician in rheumatology at the University of Toronto, said during a press conference. “This is especially important in the COVID-19 era when we are constantly faced with the challenge of balancing management of our immune-mediated disease patients against the risk of infection.”
She noted that “prior studies have indicated up to a twofold increase of infections in patients treated with biological therapy compared to the general population. However, this does not help differentiate the risks of minor infections from the serious infections that land our patients in the hospital. This is important to know when making our treatment decisions for patients.”
To determine the national trends in serious infections among patients with PsA in the United States, especially given the increased use of biologic therapies, Murugesan and colleagues from Boston University Medical Center examined discharge data from the National Inpatient Sample. The researchers identified any discharge diagnosis for PsA with a principal or secondary diagnosis of pneumonia, sepsis, UTI and/or skin and soft tissue infections using ICD-9/ICD-10 diagnostic codes.
Murugesan and colleagues then standardized results for the years 2012 to 2017 to match age distributions in the U.S. population for the year 2012, testing for trends over that period to assess for notable increases in serious infections.
According to study results, in 2012, the researchers identified 50,700 discharge diagnoses of PsA, including pneumonia (n=125), sepsis (n=230), skin and soft tissue infection (n=312) and UTI (n=174) diagnoses. Comparatively, in 2017, the researchers identified 179,400 discharge diagnoses of PsA, with a “statistically significant decrease” in discharges for sepsis (n=374), skin and soft-tissue infection (n=681) and UTI (n=348) (P < 0.001 for all), but no statistical differences in pneumonia (n=344) discharges (P = 0.89).
“Contrary to our initial hypothesis, that these patients would have an increased risk of infections, what we found instead was that the risk of serious infections had actually decreased over the past several years in this subset of patients,” Murugesan said during the press conference. “While our study showed a decrease in infections over the past several years, more studies are needed to ascertain the exact risks and the reasons. We believe that better disease control and better control of inflammation can lead to decreased risk of infection in this subset of patients. Further studies may help guide our patients to make decisions regarding the management of their arthritis while understanding their infection risk.”
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Murugesan V. Abstract 1783. Presented at: ACR Convergence 2021; November 5-9, 2021 (virtual meeting).
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