Tumor necrosis factor-antagonists in patients with autoimmune diseases showed no overall increased risk of hospitalizations for serious infections than non-biologic drugs
Tumor necrosis factor (TNF)-antagonists are a class of
biologic drugs used to treat patients with a variety of
autoimmune diseases, such as rheumatoid arthritis,
inflammatory bowel disease (IBD), and psoriasis.
Although these biologics are highly effective, concerns
exist over their potential to cause serious infections in
patients taking them, since these drugs depress the
immune system. Given this concern, some clinicians
prefer non-biologic drugs as alternatives. However, a
new study that compared both groups of drugs found
no higher risk of hospitalization for serious infections
with use of TNF-antagonists than with conventional
Working with institutions across the United States, the
researchers identified groups of patients with the
above-cited three diseases (psoriasis patients were
combined in one group with psoriatic arthritis and
ankylosing spondylitis patients). Information was
obtained on the types of medications the patients used
and the number of serious infections requiring
A total of 1,172 serious infections were identified.
More than half of these (53 percent) were pneumonia,
skin, and soft-tissue infections. No significant
difference in the hospitalization rate for serious
infections was observed between the TNF-antagonist
group and the non-biologic agent group. This result
was consistent across all autoimmune diseases studied.
Within each disease group, however, there were some
differences. For example, in patients with rheumatoid arthritis, the
use of infliximab was significantly associated with a
higher risk of serious infections compared with other
TNF-antagonists and non-biologic medications. In the
case of patients with rheumatoid arthritis, psoriasis, and
spondyloarthropathies, there was a significant dose-dependent
increase in the risk of serious infections
needing hospitalization with the use of glucocorticoids.
The study was supported in part by the Agency for
Healthcare Research and Quality (HS17919).
See "Initiation of tumor necrosis factor-antagonists
and the risk of hospitalization for infection in patients
with autoimmune diseases," by Carlos G. Grijalva,
M.D., M.P.H., Lang Chen, Ph.D., Elizabeth Delzell,
Sc.D., and others in the December 7, 2011, Journal of
the American Medical Association 306(21), pp. 2331-2339.
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