Longitudinal risk of serious infections in patients with inflammatory arthritis on immunomodulating therapy compared to controls.
Rheumatol Adv Pract
Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
Published: February 2025
Objectives: To compare the risk of serious infection across time cohorts in patients with inflammatory arthritis (IA) initiating their first biologic/targeted synthetic DMARD (b/tsDMARD), to that of the general population. Secondarily, to compare the development in infection risk during treatment across diagnoses and examine risk dynamics during the course of b/tsDMARD treatment.
Methods: Patients with IA starting their first b/tsDMARD were included from the prospective NOR-DMARD study. Controls were randomly drawn from the general population. Cox regressions were used to compare the 12-month risk of serious infections across three time cohorts following initiation (2009-2011, 2012-2014, 2015-2018) and risk during the course of treatment at 6-month intervals up to 24 months.
Results: A total of 4309 patients (RA, 1581; PsA, 1032; SpA, 1696) and 86 640 controls were included. From 2009 through 2018, 51 serious infections occurred during the first year of b/tsDMARD treatment in RA patients [hazard ratio (HR) 2.42 (95% CI 1.83, 3.21)] compared with controls and 52 serious infections were observed in patients with PsA/SpA [HR 1.91 (95% CI 1.44, 2.52)]. There were no significant differences in 12-month risk of serious infections during b/tsDMARD exposure between time cohorts. PsA/SpA patients had a consistently lower risk of serious infection compared with RA patients. The risk of serious infections did not change during the treatment course.
Conclusion: Patients with IA starting their first b/tsDMARD between 2009 and 2018 had a consistently higher 12-month risk of serious infection compared with controls. No change in the risk of serious infection across time cohorts of b/tsDMARD initiation was observed, nor during the treatment course.
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| http://dx.doi.org/10.1093/rap/rkaf017 | DOI Listing |
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