JAK inhibitors and bDMARDs not associated with increased risk of serious infections in RA

The risk of serious infections in elderly patients with rheumatoid arthritis (RA) was not increased in those who were treated with biologic (b)DMARDs or JAK inhibitors compared with patients treated with conventional systemic (cs)DMARDs. In contrast, certain comorbidities and a higher rate of disease activity were associated with a higher risk of serious infections in this population.

Mixed evidence exists on the risk of serious infections in elderly patients with RA treated with bDMARDs compared with csDMARDs. Moreover, the relation between JAK inhibitors and serious infections has not been investigated in elderly patients with RA. The current prospective cohort study collected data from the German RABBIT register to assess whether bDMARD and JAK inhibitor recipients are at an increased risk of serious infections compared with csDMARD-treated patients. Between 2007 and 2020, RA patients >70 years of age who had at least 1 follow-up appointment were included in the study. Dr Anja Strangfeld (German Rheumatism Research Centre Berlin, Germany) shared the results of the study.

In total, 2,274 elderly RA patients (mean age 76.0) were included and 616 serious infections in 425 patients were reported. Crude rates of serious infections per 1,000 patient-years were 61.5 for csDMARDs, 72.8 for TNF inhibitors, 58.4 for abatacept, 73.8 for rituximab, 54.4 for IL-6 inhibitors, and 72.1 for JAK inhibitors. No significantly increased or reduced risks of serious infections were associated with bDMARD or JAK inhibitor use compared with csDMARD use (see Figure). Disease activity, represented by DAS28 erythrocyte sedimentation rate (HR 1.11), and physical capacity (HR 0.93) were significantly associated with the risk of serious infections. After stratifying for disease activity, glucocorticoid use was no longer significantly associated with an increased risk of serious infections. COPD (HR 1.79), chronic kidney disease (HR 1.50), and diabetes mellitus (HR 1.33) were also significantly associated with an increased risk of serious infections in this population of elderly RA patients. Overall, the data is very reassuring in relationship to the sleuth of new RA-targeting DMARDS in the last 20 years and infection risk in older subjects.

Figure: Hazard ratios for serious infections associated with rheumatic treatments [1]

1. Strangfeld A, et al. Elderly patients are not at increased risk of serious infections when receiving bDMARDs or JAK inhibitors compared to csDMARD treatment. OP0116, EULAR 2021 Virtual Congress, 2–5 June.

 

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Posted on 2 August 202117 May 2024