Treatments for rheumatoid arthritis can pose risks for infections, but careful choices about medications can reduce the risks, according to a presentation by Daniel Furst, MD, a Carl Pearson Professor of Medicine and director of the Rheumatology Clinical Research Center at University of California at Los Angeles.
Non-serious infections are common with the use of methotrexate, tumor necrosis factor-alpha (TNF-a) inhibitors and non-biologic disease-modifying anti-rheumatic drugs (DMARDs) and include sinusitis and urinary tract infections in patients with rheumatoid arthritis (RA).
With Humira (adalimumab, AbbVie) and Remicade (infliximab, Janssen), the risk of non-serious infection, such as urinary tract infections or sinusitis, is high; however, the risk of a serious infection is low, according to Furst. He said the risk of infection with Enbrel (etanercept, Amgen) is much lower.
According to the results of studies conducted during the long-term in patients with RA, serious infections occur in about five patients per 100 patient-years with TNF-a inhibitors. However, the risk may be slightly higher with infliximab and slightly lower with abatacept and etanercept, Furst said.
For his patients with RA who experience infections, Furst said he usually doesn’t consider Rituxin (rituximab, Genentech), but he may consider abatacept or tocilizumab, based on the overall results of a series of studies that investigated the safety profile of the therapies. - by Shirley Pulawski
Furst, D. Session III, presentation #1. Presented at: American College of Rheumatology State-of-the-Art Clinical Symposium. May 2-3, 2015; Chicago.
Disclosure: Furst reports relationships with AbbVie, Actelion, Amgen, Bristol-Myers Squibb, Cytori, Gilead, GSK, Janssen, NIH, Novartis, Pfizer, Roche/Genentech and UCB.