In the Journals

Infection risk with abatacept lower than TNF inhibitors in RA

Seoyoung C. Kim

Patients with rheumatoid arthritis who are treated with abatacept as a first- or second-line biologic treatment have a lower risk for hospitalized infection compared with those treated with TNF inhibitors, according to data published in Arthritis Care & Research.

“Infection risk is one of the main side effects that we, rheumatologists, discuss with our RA patients when choosing/starting a biologic disease-modifying antirheumatic drug in clinic,” Seoyoung C. Kim, MD, ScD, MSCE, of Brigham and Women’s Hospital, told Healio Rheumatology. “While all DMARDs including biologic DMARDs increase the risk of infection, it is important to know more about comparative safety of different biologics for more informed medical decision making.”

To analyze the risk for hospitalized infection among patients with RA who were treated with abatacept (Orencia, Bristol-Myers Squibb) compared with a TNF inhibitor, Kim and colleagues studied de-identified medical and pharmacy claims data from the Truven MarketScan database from 2006 to 2015.

 
Patients with RA who are treated with abatacept as a first- or second-line biologic treatment have a lower risk for hospitalized infection compared with those treated with TNF inhibitors, according to data.
Source: Shutterstock

A total of 13,015 patients with RA who had newly initiated abatacept, and 52,719 who had newly begun treatment with a TNF inhibitor, were identified in the database. After propensity score matching, the researchers identified 11,248 pairs of patients initiating abatacept and a TNF inhibitor. The primary outcome was a composite endpoint of any hospitalized infection, and the secondary outcomes were bacterial infection, herpes zoster and infections targeting various organ systems.

According to the researchers, the incidence rate for any hospitalization infection among patients treated with abatacept was 37 per 1,000 person-years, compared with 47 per 1,000 person-years among those treated with TNF inhibitors. The HR for the risk of any hospitalized infection associated with abatacept, compared with TNF inhibitors, was 0.78 (95% CI, 0.640.95), and was even lower (HR = 0.63; 95% CI, 0.470.85) when compared with infliximab (Remicade, Janssen).

Kim and colleagues found no significant difference in infection risk when comparing abatacept with adalimumab (Humira, AbbVie) and etanercept (Enbrel, Amgen). The risk for pulmonary infections was lower among patients treated with abatacept for, but similar to TNF inhibitors regarding the other secondary outcomes.

“Among 11,248 propensity scorematched pairs of abatacept and TNF inhibitor initiators, we found a lower risk of hospitalized infection after initiating abatacept vs. TNF inhibitors — driven mostly by a higher risk with infliximab,” Kim said. “While further confirmation may be needed, our results suggest that RA patients at a particularly high risk for infections may benefit from use of abatacept compared to TNF inhibitors.” – by Jason Laday

Disclosure: The researchers report study funding from Bristol-Myers-Squibb. Chen reports grant support from the NIH. Please see the study for all other authors’ relevant financial disclosures.

Seoyoung C. Kim

Patients with rheumatoid arthritis who are treated with abatacept as a first- or second-line biologic treatment have a lower risk for hospitalized infection compared with those treated with TNF inhibitors, according to data published in Arthritis Care & Research.

“Infection risk is one of the main side effects that we, rheumatologists, discuss with our RA patients when choosing/starting a biologic disease-modifying antirheumatic drug in clinic,” Seoyoung C. Kim, MD, ScD, MSCE, of Brigham and Women’s Hospital, told Healio Rheumatology. “While all DMARDs including biologic DMARDs increase the risk of infection, it is important to know more about comparative safety of different biologics for more informed medical decision making.”

To analyze the risk for hospitalized infection among patients with RA who were treated with abatacept (Orencia, Bristol-Myers Squibb) compared with a TNF inhibitor, Kim and colleagues studied de-identified medical and pharmacy claims data from the Truven MarketScan database from 2006 to 2015.

 
Patients with RA who are treated with abatacept as a first- or second-line biologic treatment have a lower risk for hospitalized infection compared with those treated with TNF inhibitors, according to data.
Source: Shutterstock

A total of 13,015 patients with RA who had newly initiated abatacept, and 52,719 who had newly begun treatment with a TNF inhibitor, were identified in the database. After propensity score matching, the researchers identified 11,248 pairs of patients initiating abatacept and a TNF inhibitor. The primary outcome was a composite endpoint of any hospitalized infection, and the secondary outcomes were bacterial infection, herpes zoster and infections targeting various organ systems.

According to the researchers, the incidence rate for any hospitalization infection among patients treated with abatacept was 37 per 1,000 person-years, compared with 47 per 1,000 person-years among those treated with TNF inhibitors. The HR for the risk of any hospitalized infection associated with abatacept, compared with TNF inhibitors, was 0.78 (95% CI, 0.640.95), and was even lower (HR = 0.63; 95% CI, 0.470.85) when compared with infliximab (Remicade, Janssen).

Kim and colleagues found no significant difference in infection risk when comparing abatacept with adalimumab (Humira, AbbVie) and etanercept (Enbrel, Amgen). The risk for pulmonary infections was lower among patients treated with abatacept for, but similar to TNF inhibitors regarding the other secondary outcomes.

“Among 11,248 propensity scorematched pairs of abatacept and TNF inhibitor initiators, we found a lower risk of hospitalized infection after initiating abatacept vs. TNF inhibitors — driven mostly by a higher risk with infliximab,” Kim said. “While further confirmation may be needed, our results suggest that RA patients at a particularly high risk for infections may benefit from use of abatacept compared to TNF inhibitors.” – by Jason Laday

Disclosure: The researchers report study funding from Bristol-Myers-Squibb. Chen reports grant support from the NIH. Please see the study for all other authors’ relevant financial disclosures.