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Clinician Article

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Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis.

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• Singh JA
• Cameron C
• Noorbaloochi S
• Cullis T
• Tucker M
• Christensen R, et al.

Read abstract Read evidence summary

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Clinical Comments

Family Medicine (FM)/General Practice (GP)

Most primary care clinicians do not prescribe these biologic agents. However, primary care clinicians will undoubtedly care for patients who are candidates for them, in addition to caring for patients who are currently receiving them. Primary care clinicians need to be aware of this new information to better inform patients of the risks, and to be attuned to possible infections when they occur.

General Internal Medicine-Primary Care(US)

Good to know that my clinical experience of biologics increasing risk for infection, at least in usual and high doses, bears up in in this meta-analysis.

General Internal Medicine-Primary Care(US)

Useful meta-analysis with a pretty high increased incidence (~5%) of serious infections with high-dose biologics.

General Internal Medicine-Primary Care(US)

An excellent paper evaluating the risk for serious infections occurring in RA patients treated with biologic agents compared with patients treated with traditional disease-modifying agents. The advantages of this meta-analysis over previous studies is the inclusion of more randomised trials with a larger patient exposure, stratifying patients based on previous DMARD or anti-TNF therapy exposure, and also stratifying patients based on whether they used low-, standard-, or high-dose biologic treatment. The results clearly show an increased risk for serious infections attributed to biologic therapies in patients receiving standard or high-dose biologic therapy, but not in those receiving low-dose biologic treatment. Patients who had received traditional DMARDs or anti-TNF therapies had a higher risk than those who were methotrexate naive. Clinicians can now give patients an absolute risk of serious infections related to biologic therapies to balance the benefits of these agents.

General Internal Medicine-Primary Care(US)

This meta-analysis, the most recent and comprehensive to date, provides important new insights: there are small but significantly increased risks for infection associated with biologic mediators for treatment of RA, which rise sharply in methotrexate- or biologic mediator-experienced patients and with high-dose therapy.

Infectious Disease

Interesting analysis involving a network analysis to compare different agents.

Infectious Disease

The paper fine-tunes the info regarding serious infections associated with different doses of biologic drugs with or without prior exposure to DMARDs. Such info was not previously available.

Infectious Disease

A large comprehensive meta-analysis of the risk for infection associated with biologic therapy for rheumatoid arthritis that refines the absolute risk for infectious complications by biologic therapy dose and other patient- and therapy-level risk factors.

Internal Medicine

Drugs are commonly used now and internists need to have heightened awareness about the infection rates.

Internal Medicine

This is a highly useful paper in that it is based on five times as many participants compared with the previous large study, and it provides data we can share with our patients on the risk of therapy. Its weakness is that, in older studies, tuberculin skin testing was not done before treatment. The data suggest the risk for infection is less in more recent studies. This is the best study to date to share with our patients on infection risk.