Continuing, Switching TNFi After Serious Infection Reduces Likelihood of Recurrent Infection

MRI of knee joint
MRI of knee joint
Patients who continued or switched their TNF inhibitor after a serious infection had a lower risk for recurrent infection compared with those who stopped the drug.

Patients who continue or switch tumor necrosis factor (TNF) inhibitor therapy following a serious infection are less likely to experience a recurrent serious infection compared with those who discontinue the drug, according to a study recently published in Rheumatology.

The study included 21,943 patients receiving TNF inhibitors from the British Society for Rheumatology Biologics Register-RA, 1583 of whom experienced at least 1 serious infection associated with TNF inhibitor therapy during the follow-up period. Serious infections were defined as episodes requiring intravenous antibiotics, hospitalization, or resulting in death. Biologic treatment decisions after a serious infection were considered. Both predictors of recurrent serious infection and the influence of biologic treatment choice on future risk for serious infection were identified using a multivariable adjusted Cox proportional hazards model.

Compared with patients who stopped therapy, patients who continued their TNF inhibitor or switched drug class were less likely to experience recurrent serious infection (drug continuation hazard ratio [HR], 0.54; 95% CI, 0.40-0.74; drug switch HR, 0.29; 95% CI, 0.09-0.95). The majority (73%) continued TNF inhibitors for 60 days post-index serious infection, with a 25.6% rate of recurrent serious infection per year (95% CI, 22.5%-29.2%). Those who discontinued their TNF inhibitor were at the highest risk for recurrent serious infection, with a 42.6% rate of recurrent infection per year (95% CI, 32.5%-55.7%), while those who switched their biologic drug class were at the lowest risk, with a 12.1% rate of recurrent infection per year (95% CI, 3.9%-37.4%).

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The study researchers conclude that “patients who continued or switched their [TNF inhibitor] post-index [serious infection] had a lower risk of recurrent [serious infection] compared with those who stopped the drug. This may be explained by better control of disease activity with reintroduction of biologic therapy, a driving factor for [serious infection], or alternatively channelling fitter patients to restart biologic therapy.”

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Subesinghe S, Rutherford AI, Byng-Maddick R, Hyrich KL, Galloway JB. Biologic prescribing decisions following serious infection: results from the British Society for Rheumatology Biologics Register-Rheumatoid Arthritis [published online July 6, 2018]. Rheumatology (Oxford). doi: 10.1093/rheumatology/key198