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Does Abatacept Increase Postoperative Adverse Events in Rheumatoid Arthritis Compared with Conventional Synthetic
Hiromu Ito1,2, Shigeyoshi Tsuji3,4, Masanori Nakayama3,4
1From the Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto; Department of Orthopedic Surgery, Osaka-Minami Medical Center, Kawachi-Nagano; Department of Orthopedic Surgery, Institute of Rheumatology; Department of Orthopedic Surgery, Tokyo Women's Medical University, Medical Center East; Department of Orthopedic Surgery, The University of Tokyo Graduate School of Medicine; Department of Orthopedic Surgery, Ohmori Medical Center, Toho University School of Medicine; Department of Orthopedic Surgery, Keio University Graduate School of Medicine, Tokyo; Center for Rheumatic Diseases, Yokohama City Hospital Medical Center, Yokohama; Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Rheumatology, Niigata Rheumatic Center, Shibata; Department of Orthopedic Surgery, Nagoya University Hospital, Nagoya; Department of Orthopedic Surgery, Kamagaya General Hospital, Kamagaya; Department of Orthopedic Surgery, Kyushu Medical Center; Department of Orthopedic Surgery, Kyushu University Graduate School of Medicine, Fukuoka; Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama; Department of Orthopedic Surgery, Toho University Sakura Medical Center, Sakura; The Center for Rheumatic Diseases, Department of Orthopedic Surgery, Nara Medical University, Nara; Department of Orthopedic Surgery, Matsubara Mayflower Hospital, Kato; Department of Orthopedic Surgery, Hyogo Prefectural Kakogawa Medical Center, Kakogawa; Department of Diabetology, Kameoka Municipal Hospital, Kameoka, Japan. hiromu@kuhp.kyoto-u.ac.jp.
Objective:
To investigate whether abatacept (ABA) causes more adverse events (AE) than conventional synthetic disease-modifying antirheumatic drugs (csDMARD) after orthopedic surgery in patients with rheumatoid arthritis (RA).
Methods:
A retrospective multicenter nested case-control study was performed in 18 institutions. Patients receiving ABA (ABA group) were matched individually with patients receiving csDMARD and/or steroids (control group). Postoperative AE included surgical site infection, delayed wound healing, deep vein thrombosis or pulmonary embolism, flare, and death. The incidence rates of the AE in both groups were compared with the Mantel-Haenszel test. Risk factors for AE were analyzed by logistic regression model.
Results:
A total of 3358 cases were collected. After inclusion and exclusion, 2651 patients were selected for matching, and 194 patients in 97 pairs were chosen for subsequent comparative analyses between the ABA and control groups. No between-group differences were detected in the incidence rates of each AE or in the incidence rates of total AE (control vs ABA: 15.5% vs 20.7% in total, 5.2% vs 3.1% in death).
Conclusion:
Compared with csDMARD and/or steroids without ABA, adding ABA to the treatment does not appear to increase the incidence rates of postoperative AE in patients with RA undergoing orthopedic surgery. Large cohort studies should be performed to add evidence for the perioperative safety profile of ABA.
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