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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.