Incidence of severe infection in patients with rheumatoid arthritis taking biologic agents: a systematic review

Abstract

Objective: The objective of this review was to estimate the population-based incidence and determine the types of severe infection and deaths experienced by patients with rheumatoid arthritis taking biologic agents. Introduction: Since the late 1990s, various biologic and synthetic drugs have been developed to treat rheumatoid arthritis. In recent years, the incidence of severe infection in patients with rheumatoid arthritis in Western nations has been determined by observational studies; however, no systematic review has been conducted on this topic. Inclusion criteria: The following inclusion criteria were considered: i) observational studies on patients with rheumatoid arthritis treated with biologic agents; ii) studies reporting the number of severe infections requiring hospitalization for treatment; iii) studies reporting person-years of observation data; and iv) studies based on rheumatoid arthritis registries, medical records from rheumatology centers, or insurance claim databases. Methods: PubMed, CINAHL, Embase, and Web of Science were searched to identify published studies. The reference lists of all studies selected for critical appraisal were screened for additional studies. Unpublished studies were searched on MedNar and OpenGrey databases. All the searches were updated on December 6, 2021. After removing the duplicates, 2 independent reviewers screened titles and abstracts against the inclusion criteria and then assessed full texts against the criteria. Two reviewers independently appraised the study and outcome levels for methodological quality using the critical appraisal instrument for cohort studies from JBI. Two reviewers extracted the relevant information related to severe infection and drugs. Results: Fifty-two studies from 21 countries reported severe infection rates associated with using 8 biologic agents, plus nonbiologic disease-modifying antirheumatic drugs. In total, 18,428 infections with 395,065 person-years of biologic drug exposure were included in the analysis. Thirty-five studies included infections in outpatients receiving intravenous antibiotic therapy. Fifteen studies reported the first episode of infection, and the remaining studies did not specify either the first or all of the episodes of infection. Inclusion of viral infection and/or opportunistic infection varied among studies. Fifteen studies reported the site of infection; respiratory, skin/soft tissue, urinary tract, and sepsis/bacteremia were commonly reported. Ten studies reported the case fatality rates, ranging from 2.5% to 22.2%. Meta-analysis was conducted for 8 biologic agents and conventional disease-modifying antirheumatic drugs. The infection rate varied from 0.9 to 18.1/100 person-years. The meta-analysis revealed an infection rate of 5.0/100 person-years (95% CI 3.8–6.7) among patients receiving tumor necrosis factor inhibitors (heterogeneity 98.2%). The meta-analysis for the other 3 biologic agents revealed a point estimate of 5.5 to 8.7/100 person-years with high heterogeneity. Sensitivity analysi...

The effects of vitamin D supplementation on disease activity and fatigue in Libyan rheumatoid arthritis patients

“…Rheumatoid arthritis (RA) is a persistent autoimmune disease characterized by chronic inflammation and polyarthritis of unknown origin, impacting multiple systems in the body [ 1 ]. According to field studies, the prevalence of RA is estimated to be around 70% of the population [ 2 ]. This condition has deleterious effects on the synovium, progressing from inflammatory variations to the destruction of bone and cartilage, potentially leading to systemic inflammation affecting various organ systems in the human body [ 3 ].…”

Dengue severity in rheumatoid arthritis patients under treatment with disease‐modifying antirheumatic drugs

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Immunosuppression associated with disease-modifying antirheumatic drugs (DMARDs) administered to rheumatoid arthritis (RA) patients can increase risk for infection and more severe outcomes. 1,2 Few reports are available on the effects of DMARDs on outcomes of dengue, a mosquito-borne flaviviral infection. 3,4 Here we report observations on outcomes of dengue, including death, in RA patients treated with various classes of DMARDs.Dengue is the most common vector-borne infection globally, with >50 million cases occurring annually in tropical and subtropical locations globally.

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“…a b Adjusted for age, sex, socioeconomic status, year of diagnosis, and number of co-morbidities. c Ratio of average expenditure or length of hospital stay in days to that of the reference group 1. b/tsDMARDs-The b/ts DMARD therapies comprised rituximab, etanercept, infliximab, adalimumab, certolizumab pegol, golimumab, opinercept, tocilizumab, abatacept, ciclosporin, azathioprine, ustekinumab, mycophenolic acid, sirolimus, and cyclophosphamide; the latter four drugs are not used in RA-only patients 2.…”

Abstracts for a wider audience: promoting linguistic diversity in JBI Evidence Synthesis

“…In this issue of JBI Evidence Synthesis , we present 2 reviews featuring a translation of the review abstract. “Wants and needs for involvement experienced by relatives of patients with an acquired brain injury: a scoping review” 13 features German and Danish translations, and “Incidence of severe infection in patients with rheumatoid arthritis taking biologic agents: a systematic review” 14 includes a Japanese translation. Both of these abstracts have been translated by members of the author team and are available as supplemental digital content.…”