Wednesday, 21 Aug 2019

You are here

Steroids, Not Biologics, Drive Arthroplasty Infections in RA

Medicare and Truven MarketScan administrative data study (2006 through 2015) of rheumatoid arthritis (RA) undergoing arthroplasty found that while that the risks of perioperative infection was similar across biologics, the infection risk with glucocorticoid use, especially at > 10 mg/d, was significantly greater.

Retrospective analysis of RA patients having elective knee or hip arthroplasty, looked at the influence of recently infused biologic therapies, including abatacept, adalimumab, etanercept, infliximab, rituximab, or tocilizumab.

A total of 9911 biologic-treated patients had 10,923 surgical procedures were identified.

The risk of hospitalized infection did not vary significanly with biologic use and ranged from:

  • 6.87% with adalimumab
  • 8.16% with abatacept
  • 8.90% with rituximab C

The 1 year prosthetic joint infection (PJI) rates were:

  • 2.14% with abatacept
  • 0.35% with rituximab
  • 3.67% with tocilizumab.

However glucocorticoids were associated with a dose-dependent increase in postoperative risk for all outcomes, including hospitalized infection (13.25%;CI, 9.72% to 17.81%) (vs. 6.78% on no steroids) and a predicted 1-year cumulative incidence of PJI of 3.83% (CI, 2.13% to 6.87%) (vs. 2.09%).

 

 

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

Add new comment

More Like This

Vitamin D Supplements Fail to Prevent Type 2 Diabetes - DUH!

A NEJM report shows that the use of vitamin D3 supplementation (4000 IU per day) in those without diabetes or vitamin D deficiency failed to significantly lower risk of type 2 diabetes (compared to placebo).

The rational for this report included observational data showing an association between a low blood 25-hydroxyvitamin D level and the risk of type 2 diabetes.

Risk of Major Gastrointestinal Bleeding With New vs Conventional Oral Anticoagulants

The comparative risk for gastrointestinal bleeding (GIB) with non-vitamin K antagonist oral anticoagulants (NOACs) was compared to vitamin K antagonists or anti-platelet agents in a recent metanalysis, which showed no significant difference in major GIB events between these agents.

Rituximab Superior to Cyclosporine for Membranous Nephropathy

The NEJM has reported that rituximab (RTX) and cyclosporine (CYA) was noninferior to cyclosporine in inducing complete or partial remission of proteinuria at 12 months and was superior in maintaining proteinuria remission up to 24 months. 

Management of Hemophagocytic Lymphohistiocytosis (HLH) in Adults

Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome induced by activated macrophages and cytotoxic T cells.  HLH manifests recurrent fever, cytopenia, liver dysfunction, and a sepsis-like syndrome that may complicated by multiple organ failure.

More Trouble for Mallinckrodt’s Acthar Gel

Reuters has reported that Mallinckrodt Plc has tentatively agreed to pay $15.4 million to resolve a US Justice Department investigation into company promotional practices for Acthar gel.