Increased risk of opportunistic infection in early rheumatoid arthritis.

AIM: To estimate incidence rate (IR) and risk factors for opportunistic infections (OI) in early rheumatoid arthritis (RA) patients. METHODS: Retrospective cohorts were identified in the Korean National Claims Database. Incident RA cases were recruited in 2010 (n = 14 081). Follow up was ended at the time of development of new OI or at the date of last visit within 12 months of diagnosis. The IR and standardized incidence ratio (SIR) of OI in early and overall RA (n = 226 838) over a year were calculated. A multivariable regression model was used to identify risk factors for OI in early RA. RESULTS: The IR of OI in early and overall RA were 3.81/100 and 3.67/100 person-years, respectively. The SIR for OI in early RA was 1.14 (95% CI, 1.05-1.23). Herpes zoster (SIR = 1.12, 95% CI, 1.03-1.22) and candidiasis (SIR = 2.40, 95% CI, 1.55-3.54) were common in early RA. Age (50 < age ≤ 60 [OR 1.74, 95% CI, 1.30-2.33], 60 < age ≤ 70 [OR 1.85, 95% CI, 1.36-2.52], age > 70 [OR 1.89, 95% CI, 1.34-2.68]), female sex (OR 1.40, 95% CI, 1.12-1.74), comorbidities (one comorbidity [OR 1.53, 95% CI, 1.24-1.89], ≥ two comorbidities [OR 1.84, 95% CI, 1.47-2.29]), and corticosteroid use of 5 mg/d or more (OR 1.38, 95% CI, 1.13-1.69) were significantly associated with increased risk of OI in early RA. CONCLUSION: Opportunistic infections, especially for herpes zoster and candidiasis, tend to occur more often in early RA than in overall RA. Age, female sex, comorbidities and corticosteroid use are related to increased OI in early RA patients.

Persistence rates of abatacept and TNF inhibitors used as first or second biologic DMARDs in the treatment of rheumatoid arthritis: 9 years of experience from the Rhumadata® clinical database and registry.

BACKGROUND: Treatment persistence is an important consideration when selecting a therapy for chronic conditions such as rheumatoid arthritis (RA). We assessed the long-term persistence of abatacept or a tumor necrosis factor inhibitor (TNFi) following (1) inadequate response to a conventional synthetic disease-modifying antirheumatic drug (first-line biologic agent) and (2) inadequate response to a first biologic DMARD (second-line biologic agent). METHODS: Data were extracted from the Rhumadata® registry for patients with RA prescribed either abatacept or a TNFi (adalimumab, certolizumab, etanercept, golimumab, or infliximab) who met the study selection criteria. The primary outcome was persistence to abatacept and TNFi treatment, as first- or second-line biologics. Secondary outcomes included the proportion of patients discontinuing therapy, reasons for discontinuation, and predictors of discontinuation. Persistence was defined as the time from initiation to discontinuation of biologic therapy. Baseline characteristics were compared using descriptive statistics; cumulative persistence rates were estimated using Kaplan-Meier methods, compared using the log-rank test. Multivariate Cox proportional hazard models were used to compare the persistence between treatments, controlling for baseline covariates. RESULTS: Overall, 705 patients met the selection criteria for first-line biologic agent initiation (abatacept, n = 92; TNFi, n = 613) and 317 patients met the criteria for second-line biologic agent initiation (abatacept, n = 105; TNFi, n = 212). There were no clinically significant differences in baseline characteristics between the treatments with either first- or second-line biologics. Persistence was similar between the first-line biologic treatments (p = 0.7406) but significantly higher for abatacept compared with TNFi as a second-line biologic (p = 0.0001). Mean (SD) times on first-line biologic abatacept and TNFi use were 4.53 (0.41) and 5.35 (0.20) years, and 4.80 (0.45) and 2.82 (0.24) years, respectively, as second-line biologic agents. The proportion of patients discontinuing abatacept and TNFi in first-line was 51.1% vs. 59.5% (p = 0.1404), respectively. In second-line, it was 57.1% vs. 74.1% (p = 0.0031). The main reasons for stopping both treatments were inefficacy and adverse events. CONCLUSIONS: Abatacept and TNFi use demonstrated similar persistence rates at 9 years as a first-line biologic agent. As a second-line biologic agent, abatacept had better persistence rates over a TNFi.