Risk of serious infections in tocilizumab versus other biologic drugs in patients with rheumatoid arthritis: a multidatabase cohort study

Abstract

ObjectiveTo investigate the rate of serious bacterial, viral or opportunistic infection in patients with rheumatoid arthritis (RA) starting tocilizumab (TCZ) versus tumour necrosis factor inhibitors (TNFi) or abatacept.MethodsUsing claims data from US Medicare from 2010 to 2015, and IMS and MarketScan from 2011 to 2015, we identified adults with RA who initiated TCZ or TNFi (primary comparator)/abatacept (secondary comparator) with prior use of ≥1 different biologic drug or tofacitinib. The primary outcome was hospitalised serious infection (SI), including bacterial, viral or opportunistic infection. To control for >70 confounders, TCZ initiators were propensity score (PS)-matched to TNFi or abatacept initiators. Database-specific HRs were combined by a meta-analysis.ResultsThe primary cohort included 16 074 TCZ PS-matched to 33 109 TNFi initiators. The risk of composite SI was not different between TCZ and TNFi initiators (combined HR 1.05, 95% CI 0.95 to 1.16). However, TCZ was associated with an increased risk of 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) versus TNFi. An increased risk of composite SI, serious bacterial infection, diverticulitis, pneumonia/upper respiratory tract infection and septicaemia/bacteraemia was observed in TCZ versus abatacept users.ConclusionsThis large multidatabase cohort study found no difference in composite SI risk in patients with RA initiating TCZ versus TNFi after failing ≥1 biologic drug or tofacitinib. However, the risk of serious bacterial infection, skin and soft tissue infections, and diverticulitis was higher in TCZ versus TNFi initiators. The risk of composite SI was higher in TCZ initiators versus abatacept.

Pulmonary Cavitation – An Under-recognized Late Complication of Severe COVID-19 Lung Disease

“…15,16 In general tocilizumab is well tolerated but can induce neutropenia, and an increased risk of developing infections has been reported. 17,18 Furthermore, it may predispose to a delay in detecting active infection because of the masking effect of a suppressed C reactive protein (CRP) response. Interestingly, however, only one of 12 patients in our cohort developed neutropenia during their ICU stay.…”

Pulmonary cavitation – an under-recognized late complication of severe COVID-19 lung disease

“…16,17 In general tocilizumab is well tolerated but can induce neutropenia, and an increased risk of developing infections has been reported. 18,19 Furthermore, it may predispose to a delay in detecting active infection because of the masking effect of a suppressed C reactive protein (CRP) response. Interestingly, however, only one of 12 patients in our cohort developed neutropenia during their ICU stay.…”

Efficacy and safety of tocilizumab in COVID-19 patients: A Meta-Analysis

“…According to a previous study, the main concern regarding tocilizumab administration is the occurrence of severe bacterial infection. 51 However, only very few studies have reported data on severe infection in patients underwent tocilizumab, and it was de nitely not a contraindication for tocilizumab administration, particularly in critical patients.…”