RESEARCH - Are steroids a consistent risk factor for infections in RA patients under treatment with MTX and Enbrel?

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Clin Ter. 2009 Mar-Apr;160(2):121-3.

Are glucocorticoids a consistent risk factor for infections in

rheumatoid arthritis patients under treatment with methotrexate and

etanercept?

Luzi G, Laganà B, Salemi S, Di R.

II School of Medicine, Sapienza University of Rome, A.O. Sant',

Rome, Italy.

OBJECTIVE: To evaluate the incidence of infections in subjects with

rheumatoid arthritis (RA), treated with an anti-TNFalpha blocker

during one year follow-up. The aim of the study was focused to

evaluate the number of infectious episodes in two groups of patients

treated with etanercept (ETN) plus methotrexate (MTX) or ETN plus MTX

and glucocorticoid drugs (GCs/prednisone) for a 12 months period.

MATERIALS AND METHODS: Sixty-nine out of 122 RA patients treated with

an anti-TNFalpha drug (ETN) were included in an outpatient control

system within the Immunology Department Sapienza-University of

Rome-II; School of Medicine. RA patients were studied during the first

year after ETN introduction. Particularly 20 RA patients have been

included in a subgroup. For these 20 patients infections have been

monitored for 2 years: 12 months before and 12 months after ETN

treatment starting.

RESULTS: According to drugs administration protocols, after a careful

screening aiming to exclude latent tuberculosis infection, 20 patients

have been treated with ETN (10 of them received treatment in

association to MTX, while 10 were given a GCs therapy plus MTX).

During the one-year ETN treatment period, 7 infections have been

described in the group treated with ETN, MTX and GCs and no infection

in the group treated with ETN and MTX. After analysing the infection

number in the two groups of patients, in the year preceding biological

treatment no significant change arose.

CONCLUSIONS: The risk of infections in subjects treated with the

biological drug ETN is well known. Our data show that after one year

therapy the [ETN+MTX+GCs] group is marked by a greater frequency of

infectious episodes compared to the subjects treated with ETN plus

MTX. Therefore, the additional infectious risk appears to be related

to steroid therapy itself, though infections were not serious.

PMID: 19452100 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/19452100

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