Friday, 21 Sep 2018

You are here

Opportunistic Infections in RA Rare with Biologics

The British Society for Rheumatology Biologics Register for Rheumatoid Arthritis (BSRBR) has studied nearly 20,000 patients and observed that there is no substantially different risk of opportunistic infections (OI) between different biologics. 

The primary outcome was any serious OI excluding tuberculosis (TB).

This prospective registry has enrolled 19 282 RA patients with a total of 106 347 years of follow-up.

  • They identified a total of 142 non-TB OI for a rate of 134 cases/100 000 patient years ( or 1.3 OI per 1000 Pt-Yrs)
  • OI rates were not significantly different between the different drug classes
  • Pneumocystis infection was significantly higher with rituximab than with anti-TNF therapy (adjusted hazard ratio = 3.2)
  • TB rates dramatically fell from 783 cases/100 000 pyrs in 2002 to 38 cases/100 000 pyrs in 2015)
  • TB was significantly lower among rituximab users than anti-TNF users, with 12 cases vs. 65 cases per 100 000 pyrs

Overall, patient factors such as age, gender and comorbidity were the most important predictors of OI.

Disclosures: 
The author has received compensation as an advisor or consultant on this subject

Add new comment

More Like This

New BSR Guidelines on Biologic Safe Use with Inflammatory Arthritis

The British Society of Rheumatology has produced a set of NICE accredited guidelines for the use of biologic therapies in patients with inflammatory arthritis.

It addresses safety recommendations for all biologic therapies approved by the National Institute for Health and Care Excellence (NICE) up to June 2016, for use in all inflammatory arthritides [RA, PsA and axial SpA (SpA) including AS].

The Safety of Paternal Exposure to DMARDs and Biologics

Pregnancy and drug safety is a complex issue, often with limited informatoin about maternal drug exposure on the offspring. Greater uncertainty exists when considering whether paternal exposure may also influence fetal outcomes.

A systematic review examined the effect of disease modifying anti-rheumatic drugs (DMARDs) on male fertility and if peri-conception (within 3 months) paternal exposure was detrimental to fetal outcomes.

2018-2019 ACIP Recommendations for Seasonal Influenza Vaccination

The current issue of the CDC's MMWR reviews the new seasonal recommendations for vaccination against influenza. This is an update to the previous recommendations of the Advisory Committee on Immunization Practices (ACIP). 

Health Secretary Azar Eyes Rebate Reform

Reuters reports that the U.S. Health and Human Services Secretary Alex Azar had declared his agency has the authority to eliminate rebates on prescription drug purchases, a key element in the administration’s plan to lower prescription medicine costs.

Azar has said rebates created a perverse incentive to continuously raise drug prices.

Hydroxychloroquine Being Over-Dosed with New Guidelines?

Hydroxychloroquine retinopathy prevention guidelines have revised from ideal body weight-based dosing to actual body weight-based dosing; the question remains whether these have been adopted in clinical practice. A database of nearly 21,000 new HCQ users from a UK general population database studied HCQ dosing and use between 2007 and 2016. Specifically they examined whether users were subjected to excess HCQ dosing per ophthalmology guidelines (defined by exceeding 6.5 mg/kg of IBW and 5.0 mg/kg of ABW).