Biologic disease-modifying antirheumatic drugs (DMARDs) are not associated with increased risk for adverse respiratory events in patients with rheumatoid arthritis and chronic obstructive pulmonary disease (COPD), according to study results published in Rheumatology.

Investigators sought to assess the risk for adverse respiratory events associated with biologic and conventional synthetic DMARDs in patients with rheumatoid arthritis and COPD in a real-world population study.

Data for 7424 patients (mean age, 64.7 years; 69.7% women) who initiated biologic DMARD therapy were collected from 2 administrative databases in the United States. These patients were matched 1:1 with new users of conventional synthetic DMARDs. The most commonly prescribed biologics were etanercept (29%) and adalimumab (22%), and the most common conventional synthetic DMARDs were methotrexate (41%) and hydroxychloroquine (35%).

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Primary outcomes of interest included exacerbation of COPD requiring hospitalization, bronchitis, severe pneumonia or influenza requiring hospitalization, and outpatient pneumonia or influenza.

The incidence rate of COPD exacerbation was 1.8 per 100 person-years in the biologic DMARD group compared with 2.5 per 100 person-years in the conventional synthetic group (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.55-1.06). The risks for bronchitis (aHR, 1.02; 95% CI, 0.82-1.27), hospitalization for pneumonia or influenza (aHR, 1.21; 95% CI, 0.92-1.58), and outpatient pneumonia or influenza (aHR, 0.99; 95% CI, 0.87-1.12) were similar between users of biologic and conventional synthetic DMARDs as well.

In addition, no difference was seen in combined risk for COPD exacerbation, bronchitis, and hospitalized pneumonia or influenza between groups (aHR, 1.04; 95% CI, 0.89-1.21).

The researchers acknowledged that the observational nature of the study represented a limitation, given that residual confounding from factors such as smoking or steroid use could have affected the results.

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“Biologic drugs have revolutionized the treatment of [rheumatoid arthritis]. However, safety remains an important consideration when initiating any treatment for this disease,” the study authors concluded. “This study provides reassurance to physicians who treat [rheumatoid arthritis] patients with COPD that the risk of adverse respiratory events is not increased with biologic compared with [conventional synthetic] DMARDs.”

Disclosure: Several authors reported associations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.


Hudson M, Dell’Aniello S, Shen S, Simon TA, Ernst P, Suissa S. Comparative safety of biologic versus conventional synthetic DMARDs in rheumatoid arthritis with COPD: a real-world population study. Rheumatology (Oxford). 2020;59(4):820-827.