Risk of infection with biologic antirheumatic therapies in patients with rheumatoid arthritis

Lahiri, Manjari; Dixon, William G

doi:10.1016/j.berh.2015.05.009

Cited by 68 publications

(43 citation statements)

References 106 publications

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“…This change clarifies the intention of the Task Force, in that GC should be considered with all csDMARD starts, either as part of a first csDMARD therapy at the time of diagnosis or subsequently if an initial strategy has failed. Finally, the fact that csDMARDs are mentioned specifically implies that GC are typically not needed as a bridging therapy when bDMARDs or tsDMARDs are used, as these usually have a rapid onset of action and the infection risks may be potentiated 149 150. Thus, it is important to reiterate that the Task Force recommends using GC in combination with csDMARDs primarily as bridging therapy until the csDMARD reaches its maximum effect, and this should be done using one of the dosing and tapering approaches mentioned above, for which respective evidence exists.…”

Section: Resultsmentioning

confidence: 99%

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update

et al. 2017

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Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to—or adding—another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies.

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Section: Resultsmentioning

confidence: 99%

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update

et al. 2017

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“…An increased risk of TB and other granulomatous diseases was identified in patients treated with the monoclonal antibodies INF and ADA, initially through spontaneous reporting to national pharmacovigilance programmes [26], then subsequently in the Spanish BIOBADASAR [27] and other observational registers (summarised in [28]). Most cases of TB occurred within 6 months of starting INF, suggesting re-activation of latent TB.…”

Section: Introductionmentioning

confidence: 99%

“…This and other reports led to the introduction of a number of national guidelines for screening for and treatment of latent TB with a subsequent reduction in the rates of TB [30]. Data from RCTs suggest that the risk of TB may be higher in certolizumab pegol- and golimumab-treated patients [28]; however, most cases came from countries with a high background prevalence of TB. Results from observational data are awaited but clearly the background risk of TB is an important consideration when making decisions about biologic therapy in RA.…”

Section: Introductionmentioning

confidence: 99%

“…However, a study of 36,212 RA patients (24,384 initiating TNFis) from four US automated databases found no difference in the risk of HZ in patients initiating TNFi compared to those initiating csDMARDs after adjusting for propensity score [36]. Increasing age and glucocorticoid dose greater than 10 mg daily were additional risk factors for HZ in all these studies [28, 36]. …”

Section: Introductionmentioning

confidence: 99%

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What is the impact of biologic therapies on common co-morbidities in patients with rheumatoid arthritis?

2016

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Biologic therapies have revolutionised disease control in patients with rheumatoid arthritis (RA). Theoretically, they have the potential to influence co-morbid disease associated with RA through better control of systemic inflammation. Conversely, co-morbidity may occur as an adverse effect of the drugs. The latest evidence from observational data shows an increased risk of infection in the first 6 months of treatment with tumour necrosis factor inhibitor (TNFi) therapies and potentially other biologic therapies. Rates of infection after the first 6 months decrease and become comparable to patients with RA treated with conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs). TNFi also appear to reduce the risk of cardiovascular disease in these patients, in particular ischaemic heart disease. TNFi treatment may be associated with a small increase in the risk of developing squamous cell carcinoma of the skin; in terms of other cancers, rates appears to be no different to those seen in patients treated with csDMARDs. There is a paucity of data on the impact of other biologic therapies and the effect of all biologic therapies on other common co-morbidities.

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“…Am häufi gsten mit rund 30 % aller spontan gemeldeten Nebenwirkungen, sind lokale Injektionskomplikationen, wie sie prinzipiell bei jedem Medikament auftreten können. Dazu zählen Blutungen, Blutergüsse, Erytheme, Juckreiz, Schmerzen, Schwellungen und Urtikaria [ 15,16 ] Off-Label-Kombinationen Ciclosporin [ 31 ] , Acitretin [ 13 ] , UVB 311 nm [ 11 ] Ciclosporin [ 31 ] , Acitretin [ 12 ] , UVB 311 nm [ 14 ] Ciclosporin [ 31 ] , Acitretin [ 11 ] , UVB 311 nm [ 11,44 ] [ 20,21 ] . Risikofaktoren für eine Infektion sind eine zusätzliche immunsuppressive Therapie, Unterernährung, Alter und Begleiterkrankungen wie chronische Polyarthritis, chronische Lungenerkrankungen, Alkoholismus, organische Hirnerkrankungen und Diabetes mellitus [ 22,23 ] .…”

Section: Lokale Reaktionen An Der Injektionsstelleunclassified

Cutaneous side effects of TNF‐alpha inhibitors

Lindhaus

Tittelbach

Elsner

2017

J Deutsche Derma Gesell

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Since the early 1990s, tumor necrosis factor alpha (TNF-alpha) inhibitors have been successfully used in the treatment of various immune-mediated inflammatory diseases. By now, comprehensive safety data has been compiled. While adverse reactions do occur, they are - in relation to the frequent use of these agents - rare and usually not serious. Cutaneous side effects include local injection site reactions, infections, immune-mediated reactions, and neoplasms. The most common serious adverse events are of an infectious nature. Mycobacteria but also non-mycobacterial pathogens, such as viruses and fungi, may cause serious, even lethal, systemic infections. The present article is meant to review current knowledge with respect to cutaneous side effects of TNF-alpha inhibitors.

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Risk of infection with biologic antirheumatic therapies in patients with rheumatoid arthritis

Cited by 68 publications

References 106 publications

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update

What is the impact of biologic therapies on common co-morbidities in patients with rheumatoid arthritis?

Cutaneous side effects of TNF‐alpha inhibitors

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