Frequency of Hospitalized Infections Is Reduced in Rheumatoid Arthritis Patients Who Received Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs after 2010

Abstract EN

Background.

Biological disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic (ts) DMARDs are important in rheumatoid arthritis (RA) treatment.

The risk of hospitalized infection associated with bDMARDs/tsDMARDs in RA patients is unclear.

Methods.

We retrospectively analyzed the cases of the 275 RA patients with 449 treatment episodes who were administered a bDMARD/tsDMARD at Nagasaki University Hospital in July 2003–January 2015.

We determined the incidence and risk factors of infection requiring hospitalization in the patients during a 3-year observation period.

Results.

Thirty-five (12.7%) of the patients experienced a hospitalized infection.

The hospitalized infection risk did not differ significantly among several bDMARDs/tsDMARDs.

A multivariate analysis revealed that the comorbidities of chronic lung disease (adjusted HR 5.342, 95% CI 2.409–12.42, p<0.0001) and the initiation of bDMARDs/tsDMARDs before 2010 (adjusted HR 4.266, 95% CI 1.827–10.60, p=0.0007) are significant independent risk factors for hospitalized infection.

Compared to the before-2010 group, the group of patients whose treatment initiated in 2010 or later showed higher patient ages at the initiation of bDMARD/tsDMARD treatment and a higher rate of the use of prophylaxis with an antituberculosis agent, whereas the disease activities and number of the patients who received >5 mg of prednisolone were lower in the after-2010 group.

Conclusions.

This is the first report that the frequency of hospitalized infection significantly decreased when the patients were treated with a bDMARD or tsDMARD after 2010.

Our results indicate that the updated announcement of diagnosis and treatment criteria might contribute to a reduced risk of hospitalized infection and a better understanding of the use of bDMARDs/tsDMARDs by rheumatologists.