Risk of Serious Infections in Patients Treated With Biologic or Targeted-synthetic Disease Modifying Antirheumatic Drugs in Qatar

IF 3.1 4区医学 Q3 IMMUNOLOGY

Immunity, Inflammation and Disease Pub Date : 2025-04-14 DOI:10.1002/iid3.70195

Sreethish Sasi, Hamad Abdel Hadi, Masautso Chaponda, Reem El Ajez, Mohamed Ataelmanan, Sief Khasawneh, Hind Saqallah, Maisa Ali, Nabeel Abdulla, Javed Iqbal, Ali S. Omrani, Muna Al Maslamani, Abdullatif Al-Khal

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Abstract

Background

Biologic and targeted-synthetic disease-modifying antirheumatic drugs (b/tsDMARDs), are pivotal in the management of autoimmune-inflammatory disorders, acting by suppressing pathological immune activation. Because of associated immune dysfunction, opportunistic or serious infections (SIs), and latent disease reactivation is frequently reported. This study aimed to investigate the epidemiology, risk factors, and outcomes of SIs in patients treated with b/tsDMARDs in Qatar.

Methods

A retrospective cohort study was conducted at Hamad Medical Corporation, including all the patients treated with one of 10 b/tsDMARDs, between January 2017 and July 2021. Besides descriptive statistics, the Chi-square test and Kaplan–Meyer survival analysis were used for statistical analysis.

Results

Out of 1092 patients, 86 (7.9%) had SIs, with an incidence rate of 39.4 per 1000 patient years. Mean duration of onset was 10.8 months post-initiation of therapy. Younger age groups (18–52 years) were predominantly affected. A significant association was observed between the primary diagnosis (rheumatological followed by gastrointestinal, neurological, and dermatological disorders) and the occurrence of SIs (χ² = 9.512, p < 0.050). Adalimumab and infliximab had a higher risk of SIs compared to other b/tsDMARDs. There was no significant difference between TNF-inhibitors and others. Ocrelizumab was significantly associated with incidence of COVID-19 SIs (χ² = 16.84, p = 0.0000408), and etanercept with Staphylococcus aureus SIs (χ² = 17.51, p = 0.0000285). Predominant infection sites were skin–soft tissue and respiratory tract. Most of the SIs were secondary to either bacteria (43%) or viruses (17.4%). The mean duration of hospitalization was 9 days, and 7% of patients required critical care, with no recorded 90-day mortality.

Conclusions

Patients with inflammatory conditions managed with b/tsDMARDs are at significant risk of SIs, which necessitate appropriate patient selection weighing benefits and risks, as well as careful long-term management that include patient education and relevant preventive therapy.

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卡塔尔使用生物制剂或靶向合成改良抗风湿药物治疗的患者发生严重感染的风险

生物制剂和靶向合成抗风湿病药物（b/tsDMARDs）通过抑制病理性免疫激活在自身免疫性炎症性疾病的治疗中起关键作用。由于相关的免疫功能障碍，机会性或严重感染（SIs）和潜伏性疾病再激活经常被报道。本研究旨在调查卡塔尔b/tsDMARDs患者si的流行病学、危险因素和结局。方法在2017年1月至2021年7月期间，在哈马德医疗公司进行了一项回顾性队列研究，包括所有接受10 b/ tsdmard治疗的患者。除描述性统计外，采用卡方检验和Kaplan-Meyer生存分析进行统计分析。结果1092例患者中，86例（7.9%）发生SIs，发病率为39.4 / 1000患者年。平均发病时间为治疗开始后10.8个月。年龄较小的年龄组（18-52岁）主要受影响。初步诊断（风湿病，其次是胃肠道、神经系统和皮肤疾病）与SIs的发生存在显著相关性（χ²= 9.512,p < 0.050）。阿达木单抗和英夫利昔单抗与其他b/tsDMARDs相比具有更高的SIs风险。tnf抑制剂与其他抑制剂之间无显著差异。奥克雷珠单抗与COVID-19 SIs的发病率显著相关（χ²= 16.84,p = 0.0000408），依那西普与金黄色葡萄球菌SIs的发病率显著相关（χ²= 17.51,p = 0.0000285）。主要感染部位为皮肤软组织和呼吸道。大多数si继发于细菌（43%）或病毒（17.4%）。平均住院时间为9天，7%的患者需要重症监护，无90天死亡率记录。结论使用b/ tsdmard治疗炎性疾病的患者存在显著的si风险，因此需要权衡利弊，选择合适的患者，并进行精心的长期管理，包括患者教育和相关的预防治疗。

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来源期刊

Immunity, Inflammation and Disease Medicine-Immunology and Allergy

CiteScore

3.60

自引率

0.00%

发文量

146

审稿时长

8 weeks

期刊介绍： Immunity, Inflammation and Disease is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research across the broad field of immunology. Immunity, Inflammation and Disease gives rapid consideration to papers in all areas of clinical and basic research. The journal is indexed in Medline and the Science Citation Index Expanded (part of Web of Science), among others. It welcomes original work that enhances the understanding of immunology in areas including: • cellular and molecular immunology • clinical immunology • allergy • immunochemistry • immunogenetics • immune signalling • immune development • imaging • mathematical modelling • autoimmunity • transplantation immunology • cancer immunology