Risk of serious infections in patients with RA and PsA treated with TNFis

By Samar Mahmoud, MS
Published February 17, 2022

Key Takeaways

  • This study found that in patients treated with tumor necrosis factor (TNF) inhibitors, the risk for serious infection was significantly lower in psoriatic arthritis (PsA) patients in comparison to rheumatoid arthritis (RA) patients. 

  • Healthcare providers should consider future risk of infections when making treatment decisions for RA patients.

High levels of TNF are thought to play a role in chronic inflammatory disorders such as RA. While anti-TNF drugs are generally well-tolerated, these drugs are associated with a heightened risk of serious infections (SIs).

Why This Study Matters 

Studies comparing the risk of SIs in patients with RA and PsA are limited in the literature. To fill this gap, this study sought to estimate the incidence of SIs in patients with RA and PsA treated with tumor necrosis factor inhibitor (TNFi).

Study Design 

This study included patients with RA and PsA enrolled from the NORwegian-Disease Modifying Anti-Rheumatic Drug registry (NOR-DMARD). Participants started TNF inhibitors between January 2009 and December 2018. Investigators calculated incidence rates and compared the risk of SIs between the RA and PsA groups using an adjusted Cox-regression model. 

Results and Conclusions

The study included 2359 patients, with 1778 in the RA group and 1391 in the PsA group. Patients with RA were older and with more extensive use of co-medication in comparison to the PsA group.

The crude incidence rate for SIs was 4.17 in patients with RA and 2.16 in patients with PsA. Compared with RA patients, patients with PsA had a significantly lower risk of developing SIs. This trend remained significant even after multiple adjustments. 

Related Research

Consider these findings from similar research studies:

  • The risk of all SIs is significantly increased in patients with RA in comparison with patients with non-inflammatory rheumatic and musculoskeletal diseases (Source). 

  • Recurrent infections in RA patients are common, with patients who experienced sepsis having the highest risk of a subsequent SI within a year (Source).

Original Source 

Christensen IE, Lillegraven S, Mielnik P, et al. Serious infections in patients with rheumatoid arthritis and psoriatic arthritis treated with tumour necrosis factor inhibitors: data from register linkage of the NOR-DMARD study. Annals of the Rheumatic Diseases. 2022;81(3):398-401.

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