Chronic Disease

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 drugs.
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 hospitalization.
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.