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04-05-2024 | Shingles | BRIEF REPORT

Higher infection risk for JAK inhibitors tofacitinib and baricitinib compared to subcutaneous biological DMARDs

Authors: M. A. A. Opdam, N.den Broeder, B. J. F. van den Bemt, K. Mulder, K. M. van de Wiel, H. van Ballegooijen, R. van Crevel, A. A. den Broeder

Published in: Clinical Rheumatology | Issue 6/2024

Abstract

Introduction

Rheumatoid arthritis (RA) is usually treated with disease modifying antirheumatic drugs (DMARDs), including biological DMARDs (bDMARDs) and more recently, Janus kinase inhibitors (JAKi). Randomized trials suggest similar infection risks for JAKi and bDMARDs, but real-world data are scarce.

Methods

From a nationally representative prescription database, adult RA patients starting a new JAKi or bDMARD between August 1st, 2018, and January 31st, 2021, were included. Prescriptions of antibiotic, antiviral or antifungal medication were used as proxy for infections. Infection incidence rates (IR) were compared between JAKi and bDMARDs and infection risks were estimated using multilevel Poisson regression adjusted for follow-up time and potential confounders and stratified for age < 65 and ≥ 65 years.

Results

In 14,989 patients, we identified 20,050 treatment episodes with either JAKi or bDMARDs. The infection IR was significantly higher in JAKi (48/100 patient years) compared bDMARDs (35/100 patient years, adjusted incidence rate ratio (IRR) 1.22, 95% CI 1.12-1.33). More herpes zoster infections were seen in JAKi compared to bDMARDs (adjusted IRR 2.65, 95% CI 1.94-3.60). No significant differences in infection IRs were found comparing JAKi baricitinib and tofacitinib. In older patients, infection IRs were higher, but IRRs were similar between age groups.

Conclusion

In comparison to bDMARDs, JAKi are associated with a slightly higher infection risk and a higher risk of herpes zoster specifically. In older patients, infection IRs are higher but similar infection risks for JAKi and bDMARDs are observed. No differences in infection risk between tofacitinib and baricitinib were found.

Key Points

• Compared to bDMARDs, JAKi are associated with a slightly higher infection risk for all ages

• An increased risk of herpes zoster in patients who use JAK inhibitors was confirmed

• No significant differences in infection incidence were found between tofacitinib and baricitinib

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Title: Higher infection risk for JAK inhibitors tofacitinib and baricitinib compared to subcutaneous biological DMARDs
Authors: M. A. A. Opdam
N.den Broeder
B. J. F. van den Bemt
K. Mulder
K. M. van de Wiel
H. van Ballegooijen
R. van Crevel
A. A. den Broeder
Publication date: 04-05-2024
Publisher: Springer International Publishing
Keywords: Shingles
Disease Modifying Anti-Rheumatic Drug
Rheumatoid Arthritis
Published in: Clinical Rheumatology / Issue 6/2024
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-024-06980-x

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