Composite Infection Risk Similar for Tocilizumab vs Tumor Necrosis Factor Inhibitors in RA

Researchers found that after failed treatment with ≥1 other biologic drug or tofacitinib, patients with rheumatoid arthritis who were treated with tocilizumab or a tumor necrosis factor inhibitor were found to have the same risk for composite serious infection requiring hospitalization.

In patients with rheumatoid arthritis (RA) who have failed ≥1 biologic drug or tofacitinib, the composite serious infection risk does not differ between those initiating tocilizumab (TCZ) and those initiating tumor necrosis factor inhibitors (TNFis), according to study results published in the Annals of the Rheumatic Diseases.

However, the results did indicate that patients initiating TCZ had an increased risk for specific infections compared with patients initiating TNFis.

The study included participants with RA who initiated TCZ or TNFi/abatacept with prior use of ≥1 different biologic drug or tofacitinib. Participants were identified via claims data from US Medicare from 2010 to 2015, as well as IMS and MarketScan from 2011 to 2015. The study’s primary outcome was patients who were hospitalized with serious infection, including bacterial, viral, or opportunistic infection. Overall, the researchers identified 16,074 TCZ initiators who were propensity score (PS)-matched with 33,109 TNFi initiators.

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The risk for composite serious infection did not differ in the 2 groups, and the combined hazard ratio (HR) was 1.05 (95% CI, 0.95-1.16). However, the results indicated that TCZ was associated with an increased risk for serious bacterial infection (HR, 1.19; 95% CI, 1.07-1.33), skin and soft tissue infections (HR, 2.38; 95% CI, 1.47-3.86), and diverticulitis (HR, 2.34; 95% CI, 1.64-3.34) compared with TNFi.

Compared with abatacept users, the researchers found an increased risk for composite serious infection, serious bacterial infection, diverticulitis, pneumonia/upper respiratory tract infection, and septicemia/bacteremia in TCZ initiators.

“This head-to-head comparative safety information between TCZ and TNFi or abatacept may help better manage patients with RA in clinical practice,” the researchers wrote.


Pawar A, Desai RJ, Solomon DH, et al. Risk of serious infections in tocilizumab versus other biologic drugs in patients with rheumatoid arthritis: a multidatabase cohort study [published online January 24, 2019]. Ann Rheum Dis. doi:10.1136/annrheumdis-2018-214367