Risk of non-bacterial opportunistic infections associated with janus kinase inhibitors versus tumor necrosis factor inhibitors among rheumatoid arthritis patients: a cohort study.
Anna Shin, Rim Choi Se, Jung Yun Pyo, You-Jung Ha, Yun Jong Lee, Eun Bong Lee, Eun Ha Kang
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Abstract
Objective: To compare the risk of serious opportunistic infections between janus kinase inhibitors (JAKis) versus tumor necrosis factor inhibitors (TNFis) among rheumatoid arthritis (RA) patients.
Methods: Using 2009-2020 Korea National Health Insurance Service database, we conducted a cohort study on RA patients initiating a JAKi or TNFi. The primary outcome was a composite of hospitalized viral, fungal, and tuberculous infections. Secondary outcomes were individual components of the primary outcome. Propensity-score fine-stratification (PSS) and weighting were applied to control confounding. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models. Subgroup analyses by age, cumulative corticosteroid dose, and comorbidity score were done.
Results: During a mean follow-up of 479 days, PSS-weighted 4,252 JAKi initiators and 6,653 TNFi initiators generated 173 cases of serious opportunistic infections, of which incidence rate was 1.66 and 0.87 per 100 person-years in JAKi and TNFi users, respectively, with the PSS-weighted HR (95% CI) of 1.94 (1.44-2.64). The PSS-weighted HR (95% CI) for secondary outcomes was 2.89 (1.98-4.20) for viral, 2.07 (0.59-7.26) for fungal, 0.55 (0.27-1.15) for tuberculosis. Results were consistent across subgroups.
Conclusions: This population-based cohort study on RA patients found that the overall risk of serious opportunistic infections was higher with JAKi than TNFi. However, individual types of infections showed different patterns in that the risk of viral infections (and fungal infections only numerically) was higher among JAKi initiators, while that of tuberculosis tended to be lower in TNFi initiators.
期刊介绍：
Bimonthly e-only international journal, Joint Bone Spine publishes in English original research articles and all the latest advances that deal with disorders affecting the joints, bones, and spine and, more generally, the entire field of rheumatology.
All submitted manuscripts to the journal are subjected to rigorous peer review by international experts: under no circumstances does the journal guarantee publication before the editorial board makes its final decision. (Surgical techniques and work focusing specifically on orthopedic surgery are not within the scope of the journal.)Joint Bone Spine is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey platforms.
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