Abatacept Use During Surgery Save

The issue of medication management is a complicated one, especially in complex rheumatoid arthritis (RA) patients taking biologic or immunosuppressive drugs.  The 2016 Annual ACR meeting saw new guidelines on perioperative management and a number of abstracts suggesting the safety and advantages of continued DMARD and biologic use in those undergoing major surgery.

In the current issue of Rheumatology, investigators from the French ORA registry report on their collective experiences in 1012 RA patients receiving abatacept (ABA) an what occurred in the 205 (20.3%) patients who underwent 263 surgeries (67% were orthopedic surgeries).

Complications occurred in 7.2% of surgeries involving 19 patients (9.3% overall). This included 7 delayed wound healing (2.7% of surgeries) and 6 surgical site infections (2.3% of surgeries).

The median time from the last ABA to surgery was 5.9 weeks (range: 0.3–12.0 weeks), with no significant difference between patients with and without complications.

Those with complications were taking a higher median dose of daily corticosteroids (10.0 vs 6.0 mg/day; P = 0.042).

Overall they found a low rate of complications (7.2%) that was higher with orthopedic surgeries and in those with recent ABA initiation. The lag time between ABA infusion and surgery did not influence the rate of postoperative complications.