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No Difference Among Biologics in Arthroplasty Infectious Risk

A large administrative claims analysis of rheumatoid arthritis (RA) patients undergoing arthroplasty has shown no difference among biologics with regard to the risk of infections, but corticosteroid use was associated with a dose dependent risk of infection. 

The Annals of Internal Medicine has published an analysis of peri- and postoperative infectious risk among RA patients receiving biologics or glucocorticoids.

This was a retrospective cohort study using Medicare and Truven MarketScan administrative data from January 2006 to September 2015.

They included adult RA patients who were having elective inpatient total knee or hip arthroplasty, either primary or revision, in the setting of a recent infusion of or prescription for abatacept, adalimumab, etanercept, infliximab, rituximab, or tocilizumab before surgery. They sought to identify hospitalized infections within 30 days and prosthetic joint infection (PJI) within 1 year after arthroplasty.

A total of 9911 biologic treated patients, with 10,923 surgical procedures, were examined. Outcomes were similar despite the variety of biologics used. Hospitalized infection ranged from 6.87% risk with adalimumab to 8.9% with rituximab.

The 1-year cumulative incidence of prosthetic joint infection ranged from 0.35% with rituximab to 3.67% with tocilizumab.

Glucocorticoid use was associated with a dose-dependent increase in postoperative risk for all outcomes. When comparing more than 10 mg of glucocorticoids per day (vs. no glucocorticoid use) the predicted risks were:

  • Hospitalized infection: 13.25% vs. 6.78%, respectively
  • 1-year risk of prosthetic joint infection: 3.83% vs. 2.09%.

There appears to be no difference in risk for hospitalized infection amongst the biologics studied; glucocorticoid use, especially above 10 mg/d, was associated with greater risk for infectious complications.

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

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