Friday, 13 Jul 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

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).

NSAID Use Around Conception Increases Miscarriage Risk

A study from the American Journal of Obstetrics & Gynecology analyzed pregnant women from the Kaiser Permanente healthcare system and compared newly pregnant women who took non-steroidal anti-inflammatory drugs or acetaminophen or neither showed that using NSAIDs around conception carried a more than four-fold higher risk of early miscarriage. (Citation source: http://bit.ly/2tqNWN6)

Could Measuring Drug Levels with TNF Treatment Hurt Your Patients?

Our colleagues in gastroenterology measure drug levels with certain biologics used in inflammatory bowel disease in order to increase the dose for optimal benefit if the patient has a low trough level (i.e. targeting drug level).

There have been GI trials with T2T with drug levels but they are not always suggesting that the strategy is superior to usual care. Also, this is really not a common practice in rheumatology.

Methotrexate Update

I was delighted to see that investigators presenting work at EULAR 2018 haven’t lost interest in our old friend methotrexate, with a number of abstracts examining issues of safety, dose and route of administration.

Low incidence of methotrexate induced liver abnormalities

Cancer Therapies Inducing Immune-Related Adverse Events (irAEs)

Recent shifts in the cancer treatment paradigm towards immune therapies has led to wide implementation of the novel immune check point inhibitors (ICI) in the treatment of multiple types of advanced cancer.

While being quite effective in oncology, these checkpoint inhibitors have led to the emergence of a quite unique spectrum of rheumatologic conditions presented under the umbrella of immune-related adverse events (irAEs).