REVIEW - The risk of infections with biologic therapies for RA

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Semin Arthritis Rheum. 2010 Apr;39(5):327-46. Epub 2008 Dec 31.

The risk of infections with biologic therapies for rheumatoid arthritis.

Furst DE.

University of California Los Angeles, Los Angeles, CA 90095-1670, USA.

Abstract

OBJECTIVES: To assess the risk of serious and nonserious bacterial and

viral infections associated with the use of biologic therapy

(abatacept, adalimumab, anakinra, etanercept, infliximab, and

rituximab) in patients with rheumatoid arthritis (RA).

METHODS: Information was derived from PubMed, EMBASE, and the Cochrane

clinical trials register and database of systematic reviews and

relevant congress abstracts up to and including February 2008.

RESULTS: Compared with the general population, patients with RA have a

heightened risk of infection, including tuberculosis. Long-term

clinical trials and postmarketing studies indicate that anakinra and

the tumor necrosis factor (TNF) inhibitors are associated with an

increased risk of infections versus conventional disease-modifying

antirheumatic drugs (DMARDs), especially early in the course of

treatment. The most common sites of infection are the respiratory

tract (including pneumonia), skin and soft tissue, and the urinary

tract. The risk of tuberculosis also appears higher with TNF

inhibitors (in particular, infliximab) versus DMARDs, although this

can be reduced by screening and prophylaxis. TNF inhibitors do not

appear to significantly increase the risk of reactivating chronic

viral infections. Influenza and pneumococcal vaccinations are

generally effective in the face of TNF inhibitors or abatacept.

Available data suggest that the risk of infections and serious

infections with abatacept and rituximab may be similar to that of the

TNF inhibitors. To date, there have been no reports from clinical

trials of increased tuberculosis or opportunistic infections with

abatacept or rituximab.

CONCLUSIONS: All marketed TNF inhibitors for compared to control RA

appear to increase the risk of serious and nonserious infections

compared with DMARDs. Although suggestive, data for abatacept and

rituximab are less definitive and longer periods of patient exposure

to these agents are needed before an assessment of their risks can be

made.

PMID: 19117595

http://www.ncbi.nlm.nih.gov/pubmed/19117595

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