Risk of Infection Associated With Subsequent Biologic Agent Use After Rituximab: Results From a National Rheumatoid Arthritis Patient Registry. Issue 12 (28th November 2016)

• Record Type: Journal Article
• Authors: Harrold, Leslie R.; Reed, George W.; Karki, Chitra; Magner, Robert; Shewade, Ashwini; John, Ani; Kremer, Joel M.; Greenberg, Jeffrey D.
• Is Part Of: Arthritis care & research. Volume 68:Issue 12(2016:Dec.)
• Page Start: 1888
• Page End: 1893
• Publication Date: 2016-11-28
• Subjects: Arthritis -- Periodicals; Rheumatism -- Periodicals; 616.72
• DOI: 10.1002/acr.22912
• Languages: English
• ISSNs: 2151-464X

Abstract

Abstract : Objective: To assess whether the time between the last rituximab infusion and initiation of a different biologic agent influenced infection risk in patients with rheumatoid arthritis (RA). Methods: Patients with RA who newly initiated rituximab within the Consortium of Rheumatology Researchers of North America registry were included if they switched to a nonrituximab biologic agent and had ≥1 followup visit within 12 months of switching. Patients were categorized by duration of time between their last rituximab infusion and initiation of a subsequent biologic agent (≤5 months, 6–11 months, and ≥12 months). The primary outcome was time to first infectious event. Adjusted Cox regression models estimated the association between time to starting a subsequent biologic agent and infection. Results: A total of 44 overall infections (7 serious, 37 nonserious) were reported during the 12‐month followup in the 215 patients included in this analysis (104 switched at ≤5 months, 67 at 6–11 months, and 44 at ≥12 months). Median (interquartile range) time to infection was 4 (2–5) months. Infection rates per patient‐year in the ≤5‐month, 6–11‐month, and ≥12‐month groups were 0.34 (95% confidence interval [95% CI] 0.22–0.52), 0.30 (95% CI 0.17–0.52), and 0.41 (95% CI 0.22–0.77), respectively. After adjustment, time to switch to a subsequent biologic agent was not associated with infection, which remained unchanged when number and rate of rituximab retreatments were included in the models. Conclusion: In this real‐world cohort of patients with RA, infection rates ranged from 0.30 to 0.41 per patient‐year, with no significant difference in the rate between patients who initiated a subsequent biologic agent earlier versus later after rituximab treatment.