A recent study found that the overall infection rates for patients with rheumatoid arthritis (RA) being treated with tocilizumab or tumor necrosis factor inhibitor (TNFi) were similar, but tocilizumab may be associated with an increased risk for certain infections.
For the study, published in the Annals of the Rheumatic Diseases, researchers reviewed Medicare claims data (2010–2015) and IMS and MarketScan claims data (2011–2015) on adult RA patients initiating tocilizumab or TNFi who had previously used tofacitinib or a different biologic drug. In secondary comparisons, researchers evaluated tocilizumab initiators against abatacept initiators. Patients initiating tocilizumab were propensity score-matched to TNFi/abatacept initiators. Hospitalization for serious infection (including bacterial, viral, or opportunistic) was the primary outcome.
“should educate patients about the risk of infection in general w/ any biologics & be more vigilant for even less common types of infection (i.e., skin & soft tissue infection & diverticulitis) when treating w/ biologic drugs, particularly w/ tocilizumab” https://t.co/UbZ1waoB5c
— Amesh Adalja (@AmeshAA) February 2, 2019
Final analysis included 16,074 tocilizumab initiators who were matched to 33,109 TNFi initiators. Composite serious infection risk did not largely differ between the two groups (combined HR 1.05, 95% CI 0.95 to 1.16), but tocilizumab patients—compared to TNFi patients—had an increased risk for serious bacterial infection (HR 1.19, 95% CI 1.07 to 1.33), skin and soft tissue infections (HR 2.38, 95% CI 1.47 to 3.86), and diverticulitis (HR 2.34, 95% CI 1.64 to 3.34). When compared to abatacept patients, tocilizumab initiators had an increased risk for composite serious infection, serious bacterial infection, diverticulitis, pneumonia/upper respiratory tract infection and septicaemia/bacteraemia.
“Our results suggest that we as clinicians/rheumatologists should educate patients about the risk of infection in general with any biologics and be more vigilant for even less common types of infection (i.e., skin and soft tissue infection and diverticulitis) when treating with biologic drugs, particularly with tocilizumab,” study author Seoyoung C. Kim, MD, ScD, told MedPage Today.
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Source: Annals of the Rheumatic Diseases
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