Risk of infections in rheumatoid arthritis patients switching from anti-TNF agents to rituximab, abatacept, or another anti-TNF agent, a retrospective administrative claims analysis

Johnston, Stephen S.; Turpcu, Adam; Shi, Nianwen; Fowler, Robert; Chu, Bong-Chul; Alexander, Kimberly A.

doi:10.1016/j.semarthrit.2012.12.024

Cited by 35 publications

(30 citation statements)

References 22 publications

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“…A more recent report replicated these findings [19]. This inherent risk profile may also explain the higher rate of SI in switchers, as switchers represent a cohort of patients with more active disease, on higher doses of GC [16].…”

Section: Practice Pointsmentioning

confidence: 81%

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

Lahiri¹,

Dixon²

2015

Best Practice & Research Clinical Rheumatology

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Section: Practice Pointsmentioning

confidence: 81%

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

Lahiri¹,

Dixon²

2015

Best Practice & Research Clinical Rheumatology

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“…This loss of TNF signaling confers a bacterial growth advantage, both within the macrophage and in the extracellular space after death of the macrophage 23. It is generally known that patients with chronic inflammatory disease have an increased risk of infection for several disease-related reasons 24,25…”

Section: Discussionmentioning

confidence: 99%

Anti-TNF therapy in Jordan: a focus on severe infections and tuberculosis

Alawneh¹,

Ayesh²,

Khassawneh³

et al. 2014

BTT

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BackgroundA high rate of infection has been reported in patients receiving treatment with anti-tumor necrosis factor (anti-TNF). This study describes the rate of and risk factors for serious infections in patients receiving anti-TNF agents in Jordan.MethodsThis retrospective observational study was conducted at a large tertiary referral center in the north of Jordan. Between January 2006 and January 2012, 199 patients who received an anti-TNF agent (infliximab, adalimumab, or etanercept) were included. Patients received the anti-TNF treatment for rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease, or other conditions. A serious infection was defined as any bacterial, viral, or fungal infection that required hospitalization, administration of appropriate intravenous antimicrobial therapy, and temporary withholding of anti-TNF treatment.ResultsThe mean duration of anti-TNF treatment was 26.2 months. Steroids were used in 29.1% of patients, while 54.8% were given additional immunosuppressant therapy (methotrexate or azathioprine). Only one anti-TNF agent was given in 70.4% of patients, while 29.6% received different anti-TNF agents for the duration of treatment. Serious infections were documented in 39 patients (19.6%), including respiratory tract infections (41%), urinary tract infections (30.8%), and skin infections (20.5%), and extrapulmonary tuberculosis in three patients (7.7%). Exposure to more than one anti-TNF agent was the only factor associated with a significant increase in the rate of infection (relative risk 1.9, 95% confidence interval 1.06–4.0, P=0.03).ConclusionSerious infections, including tuberculosis, were a common problem in patients receiving anti-TNF agents, and exposure to more than one anti-TNF agent increased the risk of serious infection.

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“…Coadministration of biological factors or a combination of these therapies with high doses of corticosteroids multiplies the risk of infection and should definitively be avoided, especially in elderly patients with lung comorbidities. On the other hand, upon a developed lung infection, discontinuation of immunosuppression does not lead to precipitous reconstitution of the immune system [55,65,66,67,68,69,70,71]. All the above parameters significantly increase the risk of bacterial, mycobacterial, viral, and fungal pulmonary infections in CTD patients (fig.…”

Section: Acute Lung Infections In Ctdsmentioning

confidence: 99%

“…All the above parameters significantly increase the risk of bacterial, mycobacterial, viral, and fungal pulmonary infections in CTD patients (fig. 4, 5) [23,27,51,71,72,73,74,75,76,77,78,79,80]. …”

Section: Acute Lung Infections In Ctdsmentioning

confidence: 99%

Acute Respiratory Events in Connective Tissue Disorders

Papiris¹,

Manali²,

Kolilekas³

et al. 2016

Respiration

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Subacute-acute, hyperacute, or even catastrophic and fulminant respiratory events occur in almost all classic connective tissue disorders (CTDs); they may share systemic life-threatening manifestations, may precipitously lead to respiratory failure requiring ventilatory support as well as a combination of specific therapeutic measures, and in most affected patients constitute the devastating end-of-life event. In CTDs, acute respiratory events may be related to any respiratory compartment including the airways, lung parenchyma, alveolar capillaries, lung vessels, pleura, and ventilatory muscles. Acute respiratory events may also precipitate disease-specific extrapulmonary organ involvement such as aspiration pneumonia and lead to digestive tract involvement and heart-related respiratory events. Finally, antirheumatic drug-related acute respiratory toxicity as well as lung infections related to the rheumatic disease and/or to immunosuppression complete the spectrum of acute respiratory events. Overall, in CTDs the lungs significantly contribute to morbidity and mortality, since they constitute a common site of disease involvement; a major site of infections related to the ‘mater' disease; a major site of drug-related toxicity, and a common site of treatment-related infectious complications. The extreme spectrum of the abovementioned events, as well as the ‘vicious' coexistence of most of the aforementioned manifestations, requires skills, specific diagnostic and therapeutic means, and most of all a multidisciplinary approach of adequately prepared and expert scientists. Avoiding lung disease might represent a major concern for future advancements in the treatment of autoimmune disorders.

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Risk of infections in rheumatoid arthritis patients switching from anti-TNF agents to rituximab, abatacept, or another anti-TNF agent, a retrospective administrative claims analysis

Cited by 35 publications

References 22 publications

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

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

Anti-TNF therapy in Jordan: a focus on severe infections and tuberculosis

Acute Respiratory Events in Connective Tissue Disorders

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