Juvenile Idiopathic Arthritis Treated With Biologic Therapy: Risk Factors for Infection

hands of a child with juvenile idiopathic arthritis
hands of a child with juvenile idiopathic arthritis
Patients with juvenile idiopathic arthritis under biologic therapy in a real-world setting have high rates of serious infections.

Results from a study published in Modern Rheumatology show that patients with juvenile idiopathic arthritis (JIA) receiving biologic therapy have high rates of serious infections. The researchers also examined risk factors for these infections.

To assess rates of serious and/or opportunistic infections in patients with JIA, Juliana Barbosa Brunelli, MD, from the University of Sao Paulo in Brazil and colleagues examined 107 patients with JIA (398 patient-years) who were receiving biologic therapy at the tertiary university hospital. They used a standardized electronic database protocol that gathered data on demographics, clinical and laboratory findings, treatment at baseline, and treatment at the moment of infection. Opportunistic infections analyzed included tuberculosis, herpes zoster, and systemic mycosis. The median time of biologic exposure in the patients was 3.0 years (range: 0.15-11.5 years).

The researchers found that there were 35 serious/opportunistic infections in 27 (25%) patients. Of those infections, 31 (88.6%) were serious infections and 4 (11.4%) were opportunistic infections.

For different biologics, the serious/opportunistic infection rates were as follows: 10.6/100 patient-years for etanercept, 10.9/100 patient-years for adalimumab, 2.6/100 patient-years for abatacept, and 14.8/100 patient-years for tocilizumab.

Risk factors for infections included a higher frequency of systemic-onset JIA, lower age at initiating biologic therapy, and history of previous serious infection (P <.05).

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“In conclusion, this single-center study demonstrated a high rate of serious infections in JIA patients under biologic therapy in a real-life setting, except for [abatacept],” the researchers wrote. “Higher rates of severe infections [compared with] former studies were possibly due to elevated [methotrexate] doses in our patients.”

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Brunelli JB, Schimidt AR, Sallum AME, et al. High rate of serious infection in juvenile idiopathic arthritis patients under biologic therapy in a real-life setting [published online September 26, 2017]. Mod Rheumatol. doi:10.1080/14397595.2017.1349059