Association of Hospitalised Infection With Socioeconomic Status in Patients With Rheumatoid Arthritis Receiving Biologics or Tofacitinib: A Population-Based Cohort Study

Abstract

Objectives: Use of biologics or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) is associated with infection in patients with rheumatoid arthritis (RA). Socioeconomic status is substantial in infectious diseases; however, the impact of socioeconomic status on risk for infection in patients with RA receiving b/tsDMARD remains unclear.Methods: We used the 2003–2017 Taiwanese National Health Insurance Research Database to identify patients with RA receiving b/tsDMARDs. A Cox regression analysis was used to estimate the associations of covariates with the risk of hospitalised infection shown as hazard ratios (HRs) with 95% confidence interval (CIs).Results: We identified 7,647 RA patients who started their first bDMARD/tsDMARD treatment. Log-rank analyses demonstrated the association between age (p < 0.001), urbanisation (p = 0.001), the insured amount (p = 0.021), and the hospitalisation. Cox proportional regression analyses showed that age was independently associated with hospitalised infection in a dose–response manner, whereas a high-income category had an inverse association (HR 0.48, 95% CI 0.23–0.96). Hospitalisation for infection within 5 years was a strong risk factor (HR 5.63, 95% CI 1.91–16.62), and living in a rural area tended to be a risk factor (HR 1.76, 95% CI 0.98–3.14) for incident hospitalised infection.Conclusions: This study showed the crucial impacts of age, socioeconomic status, and history of infection on hospitalised infection in patients with RA receiving b/tsDMARDs. These findings highlight the largely ignored role of socioeconomic status in risk stratification among patients receiving b/tsDMARDs for RA.

Risk of Severe Infection among Rheumatoid Arthritis Patients on Biological DMARDs: A Population-Based Cohort Study

“…The results of the multivariable model show that age, Charlson comorbidity index, and concomitant use of corticosteroids were associated with the risk of severe infections. Age is a well-known risk factor for infections [ 22 , 31 , 32 ], thus, raising some concerns about the use of bDMARDs in the elderly. However, the overall effectiveness in patients affected by young-onset and elderly-onset RA (EORA) is similar [ 33 ]; moreover, recent data demonstrate the safety of the treat-to-target strategy also in EORA patients, supporting the use of bDMARDs in the older age groups [ 34 ].…”

Safety of synthetic and biological DMARDs: a systematic literature review informing the 2022 update of the EULAR recommendations for the management of rheumatoid arthritis

“…From a total of 2961 references (after de-duplication), 226 were selected for a full-text review and 59 observational studies fulfilled the inclusion criteria 16–74. In addition, 2 RCTs with a primary safety outcome,2 3 and 28 RCTs/LTEs from the efficacy SLR,75–102 were included (flow chart in online supplemental figure S1).…”

“…Of 59 observational studies, 51 assessed only 1 outcome,16–66 and 8 addressed ≥2 outcomes (online supplemental table S1–137). 67–74 Of 27 studies evaluating the risk of infections,27–47 67 69 71–74 23 included patients on bDMARDs,27–29 31–33 35–37 39–47 69 71–74 9 of which also patients on JAKi,27 28 30 31 42 45 69 71 72 3 only patients on csDMARDs34 38 67 and 1 patients either on tofacitinib or on csDMARDs 30. Nine studies evaluated the risk of malignancies with bDMARDs,48–53 71 73 74 and one of these also with tofacitinib 71.…”

“…Of 27 studies addressing the risk of infections, 3 compared bDMARDs/JAKi to the general population,27 44 47 8 compared bDMARDs/JAKi to csDMARDs,28 30–32 35 36 46 72 3 compared the risk across csDMARDs34 38 67 and 13 across bDMARDs/JAKi29 33 35 37 39–43 45 69 71 74 (table 1 and online supplemental tables S2–S43).…”

Data_Sheet_1.pdf

“…Biologics are widely used in treating moderate to severe psoriasis, psoriatic arthritis, rheumatoid arthritis, and hidradenitis suppurativa (1)(2)(3)(4). Systemic lupus erythematosus (SLE) induced by biologics mostly occurs during the treatment of psoriasis with tumor necrosis factor-alpha (TNFα) inhibitors, especially in patients with psoriatic and rheumatoid arthritis.…”