In a nutshell
This study reviewed infection risk in patients treated with biologic and targeted disease-modifying anti-rheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA).
Some background
Rheumatoid arthritis (RA) is a chronic condition. It is caused by painful inflammation in the joints. RA is treated with drugs to reduce inflammation. They are called disease-modifying anti-rheumatic drugs (DMARDs). There are several types of DMARDs. Biological DMARDs (bDMARDs) act on proteins and chemicals that cause inflammation. BDMARDs are designed to target a specific inflammatory protein. Some common targets are tumor necrosis factor (TNF) and interleukins (ILs). Targeted DMARDs (tDMARDs) block enzymes involved in inflammation. Janus kinase (JAK) enzymes are a common target.
BDMARDs and tDMARDs suppress the immune system. This can increase the risk of infection. Managing the infection risk is important in caring for patients with RA.
Methods & findings
This article reviewed expert opinion on infection as a side effect of targeted and biological therapies for RA.
TNF inhibitors (TNFi) such as certolizumab (Cimzia), infliximab (Remicade), adalimumab (Humira) increase the risk of infection. TNFi treatment should be stopped if a patient has an infection. Patients should be screened (checked) for tuberculosis (TB) before starting TNFis. Patients should also be screened for hepatitis B (hepB) infection. Vaccination against some pathogens is recommended. Live virus vaccines may not be suitable for patients treated with TNFis.
IL-6 inhibitors (Il-6i) such as sarilumab (Kevzara) or tocilizumab (Actemra) increase the risk of infection. There is a slightly lower risk of TB. Patients should still be screened for TB before starting IL-6i treatment. JAK inhibitors (JAKi) such as baricitinib (Olumiant) and tofacitinib (Xeljanz) increase the risk of herpes zoster infection.
Rituximab (Rituxan) is a drug that blocks a protein called CD20. It can increase the risk of HepB infection. Patients should be screened for HepB before starting treatment.
Treatment with bDMARD/tDMARDs should be stopped before receiving a live vaccine. The stop time should be discussed with a doctor.
The bottom line
This study reviewed infection risk in patients with RA treated with biologic and targeted DMARDs.
What’s next?
This was a review of managing infection risk. Each patient’s treatment is individual. You should discuss infection risk with your doctor before beginning treatment.
Published By :
Annals of the rheumatic diseases
Date :
Sep 22, 2020
