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Immunosuppressive Medications and Nonserious Infections in People With Rheumatoid Arthritis: A Prospective Cohort
Michael D George1, Kelly Gavigan2, Shilpa Venkatachalam2
1Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Objective:
People with rheumatoid arthritis (RA) are at increased risk of serious infection, but less is known about nonserious infections. Our prospective cohort study evaluated associations between medications for RA and the risk of nonserious infections.
Methods:
We remotely recruited adults with RA in a community rheumatology practice-based research network. Participants joined the ArthritisPower Registry (now PatientSpot) and completed a baseline and up to six monthly follow-up surveys. Using data from consecutive monthly surveys, we assessed associations between medication use at the prior survey and infection report at the subsequent survey, adjusting for confounders.
Results:
We recruited 351 people with RA (mean age 60, 84% female) who reported 439 infections (330 infections per 100 patient-years). Associations between medication use and infection were assessed among 1,075 qualifying observations with 289 (27%) total infections and 146 (14%) infections with health care encounters or antibiotic use. Compared to those receiving conventional synthetic disease-modifying antirheumatic drugs who were biologic or JAK inhibitor (JAKi) naïve, current biologic or JAKi use was not associated with either infection outcome. Infections were numerically more common with glucocorticoids ≥10 mg/day (odds ratio 1.94, 95% confidence interval 0.89-4.24). Season, previous infection, poorer function, and rural residence were significantly associated with one or both infection outcomes.
Conclusion:
Biologics and JAKi were not associated with greater risk for nonserious infections compared to conventional therapies. Given that nonserious infection risk may be due more to exposures and general health status, future studies should assess whether the common practice of interrupting medications in people with infection improves or worsens outcomes.
Insights
Biologics and JAK inhibitors did not increase nonserious infection risk in rheumatoid arthritis patients compared to conventional drugs. Other factors like season and health status were more significant. Further research is needed on medication interruption during infection.
Area of Science:
- Rheumatology
- Infectious Disease Epidemiology
- Pharmacovigilance
Background:
- Rheumatoid arthritis (RA) patients face higher serious infection risks.
- Nonserious infection risks associated with RA medications are less understood.
- Prospective cohort studies are crucial for evaluating medication-associated infection risks.
Purpose of the Study:
- To investigate the association between rheumatoid arthritis (RA) medications and the risk of nonserious infections.
- To compare infection risks among patients using biologics, JAK inhibitors, and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).
Main Methods:
- A prospective cohort study involving 351 adults with RA recruited remotely.
- Monthly surveys were used to assess medication use and infection reports.
- Statistical models adjusted for confounders to evaluate medication-infection associations.
Main Results:
- Biologic or JAK inhibitor use was not linked to increased nonserious infection risk compared to csDMARDs.
- Glucocorticoid use (≥10 mg/day) showed a numerical increase in infection risk (OR 1.94).
- Season, prior infection, functional status, and rural residence were significant infection risk factors.
Conclusions:
- Biologics and JAK inhibitors do not appear to elevate nonserious infection risk in RA patients.
- Nonserious infections may be more influenced by environmental exposures and overall health status.
- Future research should examine the impact of temporarily stopping RA medications during infections.
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