Risk of infections in psoriatic arthritis or axial spondyloarthritis patients treated with targeted therapies: A meta-analysis of randomized controlled trials

• Published in: Joint, bone, spine : revue du rhumatisme bone, spine : revue du rhumatisme, 2024-05, Vol.91 (3), p.105673-105673, Article 105673
• Main Authors: Séauve, Milène, Auréal, Mélanie, Laplane, Soline, Lega, Jean-Christophe, Cabrera, Natalia, Coury, Fabienne
• Format: Article
• Language: English
• Subjects: Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Arthritis, Psoriatic - complications; Arthritis, Psoriatic - drug therapy; Axial spondyloarthritis; Biologic and targeted synthetic therapies; Biological Products - adverse effects; Biological Products - therapeutic use; Female; Humans; Infections; Infections - epidemiology; Life Sciences; Male; Meta-analysis; Molecular Targeted Therapy - methods; Psoriatic arthritis; Randomized Controlled Trials as Topic; Relative risk; Risk Assessment; Spondylarthritis - complications; Spondylarthritis - drug therapy
• ISSN: 1297-319X; 1778-7254
• DOI: 10.1016/j.jbspin.2023.105673

•Metaanalysis to evaluate the risk of global infection of biological or targeted therapies in spondyloarthritis, psoriatic arthritis (PsA) and axial spondyloarthritis (ankylosing spondylitis [AS] and non-radiographic [nr-axSpA]).•The risk of global infections is increased under b/tsDMARDs in spondyloarthritis (RR 1.15, 95% CI [1.06–1.25]), especially under TNF and IL-17 inhibitors.•It seems to be not the case for serious infections. To evaluate the risk of global infections in patients with psoriatic arthritis (PsA) and axial spondyloarthritis encompassing ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) treated with targeted therapies. Medline and Cochrane databases were systematically searched up to March 2021 for randomized controlled trials (RCTs) performed in patients with PsA or axial spondyloarthritis treated with biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). Global infections (any infections reported, including bacterial, viral and fungal infections, except serious infections) were the primary outcome. Secondary outcomes included serious infections defined as life-threatening infections or any infection requiring intravenous antibiotics or hospitalization. The relative risk of infections was determined by meta-analysis of RCTs. A total of 60 RCTs were included (20,418 patients), encompassing 17 b/tsDMARDs, compared with placebo, conventional synthetic drugs (csDMARDs) or non-steroidal anti-inflammatory drugs (NSAIDs). An increased risk of any infection for patients exposed to these drugs was found (RR 1.15, 95% CI [1.06–1.25]), mainly with high doses and longer duration of treatment. Most infections were respiratory tract or ear, nose, and throat (ENT) infections. Subgroup analyses showed a statistically significant increased risk of infections for axial spondyloarthritis patients (RR 1.32, 95% CI [1.14–1.52]), but not for PsA patients (RR 1.05, 95% CI [0.97–1.14]). Infection risk was highest with TNF inhibitors (RR 1.23, 95% CI [1.11–1.37]) and IL-17 inhibitors (RR 1.30, 95% CI [1.07–1.59]). No increased risk of serious infections was shown. In contrast to serious infections, the risk of global infections is moderately increased with b/tsDMARDs in spondyloarthritis, and is associated in particular with use of TNF and IL-17 inhibitors.