Severe infection in patients with rheumatoid arthritis taking anakinra, rituximab, or abatacept: a systematic review of observational studies

• Published in: Revista Brasileira de Reumatologia Vol. 56; no. 6; pp. 543 - 550
• Main Authors: Cabral, Vanderlea Poeys, Andrade, Carlos Augusto Ferreira de, Passos, Sonia Regina Lambert, Martins, Maria de Fátima Moreira, Hökerberg, Yara Hahr Marques
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Reumatologia 01-11-2016
• Subjects: Abatacept; Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Antirreumáticos/efeitos adversos; Arthritis, Rheumatoid - drug therapy; Artrite reumatoide/terapia; Humans; Immunologic Factors - adverse effects; Immunologic Factors - therapeutic use; Infecção; Interleukin 1 Receptor Antagonist Protein; Revisão de literatura como assunto; Rituximab; Terapia biológica/efeitos adversos; Infection; Terapia biológica/efeitos adversos; Review of literature as topic; Infecção; Anti-rheumatic drugs/adverse effects; Artrite reumatoide/terapia; Biological therapy/adverse effects; Antirreumáticos/efeitos adversos; Revisão de literatura como assunto; Rheumatoid arthritis/therapy
• ISSN: 1809-4570; 2255-5021
• DOI: 10.1016/j.rbre.2016.10.001

A question is raised about an increased risk of severe infection from the use of biological drugs in patients with rheumatoid arthritis. This systematic review of observational studies aimed at assessing the risk of severe infection associated with the use of anakinra, rituximab, and abatacept in patients with rheumatoid arthritis. The following databases were searched: PubMed, Science Direct, Scopus, Web of Knowledge, Scirus, Cochrane, Exerpta Medica Database, Scielo, and Lilacs up to July 2010. Severe infections were defined as those life-threatening ones in need of the use of parenteral antibiotics or of hospitalization. Longitudinal observational studies were selected without language restriction, involving adult patients diagnosed with rheumatoid arthritis and who used anakinra, rituximab, or abatacept. In four studies related to anakinra, 129 (5.1%) severe infections were related in 2896 patients, of which three died. With respect to rituximab, two studies reported 72 (5.9%) severe infections in 1224 patients, of which two died. Abatacept was evaluated in only one study in which 25 (2.4%) severe infections were reported in 1046 patients. The main site of infection for these three drugs was the respiratory tract. One possible explanation for the high frequency of severe infections associated with anakinra may be the longer follow-up time in the selected studies. The high frequency of severe infections associated with rituximab could be credited to the less strict inclusion criteria for the patients studied. Therefore, infection monitoring should be cautious in patients with rheumatoid arthritis in use of these three drugs.