Annals of the Rheumatic Diseases | 2019
FRI0062\u2005INFECTIONS AMONG RHEUMATOID ARTHRITIS PATIENTS STARTING OR SWITCHING BIOLOGICAL AGENTS. A SYSTEMATIC LITERATURE REVIEW
Abstract
Background The increased rate of infections is one of the most relevant issues regarding biologic therapies in Rheumatoid Arthritis (RA). There is a large number of studies comparing different biologic agents and biologic vs synthetic DMARDs in order to assess their safety profile. Nevertheless, the main question is whether biologics really increase the infection risk by themselves. Up to date, different studies tried to clarify the actual role that these drugs have in this potentially serious adverse effect, searching for other predisposing conditions related to patient clinical characteristics. Objectives To compare the risk of infections between patients starting biologic for the first time (naïve) and patients with an inadequate response to a previous biologic agent (switchers) Methods A search strategy was performed by the Spanish Society of Rheumatology documentalist over Pubmed, Embase and Cochrane Library databases (from January 2008 to February 2018). All the references retrieved were managed using Endnote X7®. Screening of studies, data collection and data analysis was performed by 2 reviewers. Meta-analysis, systematic reviews of Randomized Controlled Trials (RCT), Clinical Trials or Cohort studies, comparing data from adult RA patients starting biologics and switching biologics, were selected. After the first screening, a critical review was performed using electronic FLC platform for critical appraisal tools (Osteba®) and The Scottish Intercollegiate Guidelines Network (SIGN) was considered to classify the scientific evidence of the selected studies. Studies including patients with chronic infections, tuberculosis reactivations or surgical infections were excluded. Results 8 studies were included: 1RCT, 2 Open label study, 1 Open label extension from RCT, 2 subgroups analysis from RCTs and 2 prospective cohort studies. Overall infection rate was higher in switchers than in naïve patients, with a mean variation between 0-9 and 1.8 100 PY, serious infections were also higher in switchers patients, 2.2 100PY. In both groups, (naïve and switchers), patients treated with more cumulative dose of glucocorticoids (GC) had an increased risk of infections, and it was higher in patients with an inadequate response to previous biologic agents. Mean disease duration was longer in switchers, but this fact was not related to increase of infections. Conclusion This systematic review show that overall rate of infections is slightly higher in switchers than in naïve patients, but the fact of having received several biologic agents does not present itself as a risk factor for infection. However, the most important risk factor in the development infections was the higher cumulative doses of GC. \nDisclosure of Interests None declared