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Timing of Abatacept Before Elective Arthroplasty and Risk of Postoperative Outcomes

Michael D George1, Joshua F Baker2, Kevin Winthrop3

  • 1University of Pennsylvania Perelman School of Medicine, Philadelphia.

Arthritis Care & Research
|February 12, 2019
PubMed

Insights

Withholding abatacept infusions before hip and knee arthroplasty for four weeks or more did not reduce postoperative infection risk. Optimal timing for biologic therapy cessation remains unclear for patients undergoing joint replacement surgery.

Area of Science:

  • Rheumatology
  • Orthopedic Surgery
  • Pharmacology

Background:

  • Current guidelines suggest withholding biologic therapies before hip and knee arthroplasty, but evidence for optimal timing is limited.
  • Abatacept is a biologic therapy commonly used for rheumatoid arthritis.

Purpose of the Study:

  • To investigate whether withholding abatacept infusions before hip and knee arthroplasty is associated with a reduced risk of adverse postoperative outcomes.
  • To determine the optimal duration for discontinuing abatacept prior to joint replacement surgery.

Main Methods:

  • Retrospective cohort study using US Medicare and Truven MarketScan administrative data (2006-2015).
  • Evaluated adults with rheumatoid arthritis receiving intravenous abatacept within 6 months of hip or knee arthroplasty.
  • Propensity weighted analyses compared risks of 30-day hospitalized infection, 1-year prosthetic joint infection (PJI), nonurinary infections, and 30-day readmissions based on abatacept cessation timing.

Main Results:

  • No significant differences in hospitalized infection, nonurinary hospitalized infection, PJI, or 30-day readmission rates were observed between patients withholding abatacept for <4 weeks versus 4-8 weeks or ≥8 weeks.
  • High-dose glucocorticoid use (>7.5 mg/day) was associated with an increased risk of hospitalized and nonurinary hospitalized infections.

Conclusions:

  • Withholding abatacept for ≥4 weeks before hip and knee arthroplasty was not associated with a lower risk of postoperative infections or readmissions.
  • The optimal timing for discontinuing abatacept infusions before joint replacement surgery requires further investigation.
Abstract

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