RA Biologics Risk of Infection Less with Abatacept

The choice of a biologic agent for treating rheumatoid arthritis (RA) may influence a patient’s risk of serious infections, shows a study that suggestsabatacept may have less infection risks for some patients as compared toetanercept, infliximab and rituximab.¹ 

Previous studies have shown biologic agents to be effective in treating rheumatoid arthritis, but they have been linked to an increase in hospitalized infections. In one study, patients who received infliximab, adalimumab or certolizumab had significantly higher rates of hospitalized infections as compared to patients who were given a placebo or disease-modifying anti-rheumatic drugs (DMARDs).^2-5 Another study showed that the biologics abatacept, adalimumab, etanercept and rituximab were associated with lower rates of hospitalized infections as compared to patients prescribed infliximab⁶.

A more recent study, published online Dec. 23, 2015 in Arthritis and Rheumatology,confirms the results of a previous study showing that abatacept is associated with fewer hospitalized infections as compared to patients treated with etanercept, infliximab and rituximab.[[{"type":"media","view_mode":"media_crop","fid":"46985","attributes":{"alt":"©Ralwel/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_6799919425205","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5495","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©Ralwel/Shutterstock.com","typeof":"foaf:Image"}}]]

The study, which was led by Jeffrey R. Curtis, M.D., M.P.H., of the University of Alabama, is based on an analysis of Medicare data for 31,801 rheumatoid arthritis patients who were treated from 2006-2011 and who, prior to 2006, were treated with a different biologic.

Between 2006-2011, approximately 28.9% of patients were prescribed abatacept, 15.2% were prescribed adalimumab, and 14.8% received rituximab; others received etanercept, certolizumab, golimumab, infliximab or tocilizumab.

During this period there were 2,530 hospitalized infections with incidence rates ranging from 13.1 per 100 person-years (abatacept) to 18.7 per 100 person-years (rituximab).  Three biologic agents had higher hazard ratios for hospitalized infection as compared to abatacept:  etanercept (HR 1.24; 95% CI: 1.07-1.45); infliximab (HR 1.39; 95% CI: 1.21-1.60); and rituximab (HR 1.36; 95% CI: 1.21-1.53).

“Our findings showed that among RA patients who had previously been exposed to different biologic agents, the 1-year risk of hospitalized infection was significantly higher in those exposed to etanercept, infliximab or rituximab compared with those exposed to abatacept,” the authors wrote. “For those in whom the treatment was continued for longer than 12 months, the infection rates for each medication were generally all lower, but significant differences in the rate of hospitalized infection between abatacept and the other biologic agents (including adalimumab and golimumab) were observed.”

In selecting a biologic agent for patients, the authors urge physicians to consider the safety profile of the specific biologic, but also other factors – such as the use of glucocorticoids.

References:

1.       Yun H, Xie F, Delzell E, et al.

Comparative risk of hospitalized infection associated with biologic agents in rheumatoid arthritis patients enrolled in Medicare. 

Arthritis & Rheumatology.

 2016;68(1):56-66. DOI: 10.1002/art.39399. 2. Keystone EC, Kavanaugh AF, Sharp JT, Tannenbaum H, HuaY, Teoh LS, et al. Radiographic, clinical, and functional out-comes of treatment with adalimumab (a human anti–tumornecrosis factor monoclonal antibody) in patients with activerheumatoid arthritis receiving concomitant methotrexate therapy:a randomized, placebo-controlled, 52-week trial. Arthritis Rheum2004;50:1400–11. 3. St.Clair EW, van der Heijde DM, Smolen JS, Maini RN, BathonJM, Emery P, et al, for the Active-Controlled Study of PatientsReceiving Infliximab for the Treatment of Rheumatoid Arthritisof Early Onset Study Group. Combination of infliximab andmethotrexate therapy for early rheumatoid arthritis: a random-ized, controlled trial. Arthritis Rheum 2004;50:3432–43. 4. Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL,Montori V. Anti-TNF antibody therapy in rheumatoid arthritisand the risk of serious infections and malignancies: systematicreview and meta-analysis of rare harmful effects in randomizedcontrolled trials. JAMA 2006;295:2275–85. 5. Singh JA, Wells GA, Christensen R, Tanjong Ghogomu E, MaxwellL, Macdonald JK, et al. Adverse effects of biologics: a networkmeta-analysis and Cochrane overview. Cochrane Database Syst Rev2011:CD008794
 6. Curtis JR, Xie F, Chen L, Baddley JW, Beukelman T, Saag KG,et al. The comparative risk of serious infections among rheuma-toid arthritis patients starting or switching biological agents. AnnRheum Dis 2011;70:1401–6