Monday, 24 Feb 2020

You are here

Interleukin Targeted Biologics Increase Risks of Infection

A systematic review of the literature shows that, compared to placebo, the use of non-TNF, interleukin inhibitor biologics may be associated with significantly higher rates of serious infections, opportunistic infections, and cancer.

The authors performed a fixed-effects meta-analysis to assess the influence of non-TNF, interleukin inhibitor biologics on reported rates of serious infections, opportunistic infections, and/or cancers. IL Inhibitors (and their cytokine target) included were: anakinra (IL-1), rilonacept (IL-1), canakinumab (IL-1), tocilizumab (IL-6), olokizumab (IL-6), clazakizumab (IL-6), sirukumab (IL-6), sarilumab (IL-6), ustekinumab (IL-12/23), brodalumab (IL-17), secukinumab (IL-17), ixekizumab (IL-17), and guselkumab (IL-23). 

The study included 74 studies and 29,214 patients (24 236 patients for serious infections, 9998 for opportunistic infections, and 21 065 for cancer patients). 

IL inhibitor treated patients had a higher risk of:

  • Serious infections (OR, 1.97; 95% CI, 1.58-2.44; P < .001)
  • Opportunistic infections (OR, 2.35; 95% CI, 1.09-5.05; P = .03)
  • Cancer (OR, 1.52; 95% CI, 1.05-2.19; P = .03)

Analysis of individual drugs shows that not all interleukin inhibitors were associated with significantly higher rates.

This is one of the few studies to show ab increased risk of opportunistic infections with IL inhibitor therapy.

The authors note that this study has limitations. These results must be interpreted with caution because of factors intrinsic to the analysis of study-level data. This analysis assumes that the risk of infections or cancer is constant throughout the duration of treatment. Previous data have suggested that the risk for infection with TNF inhibitors is highest within the first 90 days of therapy, but to our knowledge, no data are currently available concerning use of IL inhibitors. 

The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Tofacitinib Effective in Refractory Still's Disease

Fourteen cases reported from mainland China suggest that tofacitinib (TOFA) may be effective in patients with refractory adult-onset Still’s disease (AOSD), further adding to a growing list of potential use of JAK inhibition in managing inflammatory, and now autoinflammatory, disease.

QD Clinic - Hepatitis B and Biologics

QD Clinic - Lessons from the clinic Active HBV infection (HGsAg+) on anti-viral therapy but needs a biologic - what should you use?

Biosimilars for Rheum Disease: Failure to Launch

The availability of biologic biosimilars has thus far had negligible impact on prescribing practices in the United States, in stark contrast to what has been observed in some European countries, researchers reported.

Best of 2019 - Is Methotrexate Necessary with Tofacitinib?

Rheumatoid arthritis patients taking tofacitinib (Xeljanz) plus methotrexate who achieved low disease activity (LDA) may be able to withdraw from the latter agent without significant worsening of disease activity, a researcher reported at EULAR 2019 in Madrid.

Best of 2019 - Ups and Downs with Abatacept

Two recent studies have examined the effect of starting abatacept upon the risk of serious hospitalized infections or cancer, showing divergent results from claims data analyses.