Materne et al. investigated the comparative risk of infection with belimumab, an injectable immunosuppressant, vs. oral immunosuppressants for the treatment of systemic lupus erythematosus (SLE). The researchers designed and emulated hypothetical target trials to estimate the cumulative incidence and hazard ratios of serious infection and hospitalization using data from TriNetX, a federated electronic health record database. In three parallel arms, they separately compared initiation of belimumab with azathioprine, belimumab with methotrexate, and belimumab with mycophenolate. Belimumab was associated with lower risks of serious infection than oral immunosuppressants.
JAK Inhibitors vs. TNF Inhibitors: Understanding Infection Risks
Research from Choi et al. provides insights into the risk of infection in patients with rheumatoid arthritis (RA), comparing patients treated with Janus kinase inhibitors vs. tumor necrosis inhibitors. The most frequent infection was herpes zoster, with patients treated with JAK inhibitors having a significantly greater risk of herpes zoster infection than those treated with TNF inhibitors.
Nonserious Infection Rates with Biologics Used to Treat RA
Bechman et al. set out to describe the frequency and predictors of nonserious infections and compare incidence rates across biologic DMARDs. They found all bDMARDs are associated with a greater risk of nonserious infection, with differences observed between agents. Although unmeasured confounding must be considered, the magnitude of effect is large.
Case Report: A Mycobacterium kansasii Infection
A 61-year-old white woman presented to our rheumatology clinic in New England to establish care in early June 2018, following a move from Texas. She reported a medical history of inflammatory bowel disease, uveitis and seronegative inflammatory arthritis, which was difficult to control and required the use of multiple medications. At her initial visit, she…
Case Study: Cerebral Toxoplasmosis in a Newly Diagnosed Lupus Patient
The occurrence of opportunistic infections is an established complication in patients diagnosed with systemic lupus erythematosus (SLE). The foremost challenge in such circumstances is differentiating between an exacerbation or progression of SLE, and the effects of the infection itself.1 Toxoplasma gondii is a ubiquitous parasite that often causes an asymptomatic infection in healthy, immunocompetent adults….
Case Report: A Non-Tuberculous Mycobacterial Infection
Tumor necrosis factor-α inhibitors (TNFi’s) have emerged as an integral part of therapeutic strategies for several rheumatic diseases. TNF-α is a pro-inflammatory cytokine implicated in the pathogenesis of rheumatoid arthritis (RA), seronegative spondyloarthropathies and inflammatory bowel disease (IBD). It also plays a central role in the immune response to mycobacterial infection. Many biologic agents, particularly…
Case Report: Is It Reactive or IBD-Associated Arthritis?
Reactive arthritis is classically associated with an infectious etiology, such as Salmonella, Yersinia, Campylobacter, Chlamydia or gonorrhea. Clostridium difficile is a rare, and recently recognized, causative agent for this condition.1 Case Presentation The patient is a 21-year-old man with a past medical history significant for hereditary spherocytosis and Crohn’s disease, complicated by an anorectal fistula,…
Denosumab Tied to Infection Risk
NEW YORK (Reuters Health)—The osteoporosis drug denosumab is associated with a higher incidence of serious infections compared with placebo, but the risk is similar to comparator drugs, a systematic review and meta-analysis reveals. Talia Diker-Cohen, MD, PhD, of Tel Aviv University, and colleagues searched the literature through May 2019 for randomized controlled trials of denosumab…
History of Infection Linked to Primary Sjögren’s Syndrome
In a recent investigation of Swedish patients, environmental triggers of the immune system are a common factor for patients with primary Sjögren’s syndrome…
Trimethoprim-Sulfamethoxazole Prophylaxis Reduced Rituximab Infection Risk
Severe infections occurred in 25% of patients with anti-neutrophil cytoplasm antibody (ANCA) associated vasculitis (AAV) who were treated with rituximab, according to results of an observational study conducted in the United Kingdom (U.K.) and Austria. Trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis, however, reduced the risk of severe infections, the investigators reported in Annals of the Rheumatic Diseases.1 Andreas…
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