Biologic therapy increases infection risk in elderly patients of rheumatoid arthritis

Biologic therapy increases risk of infection in elderly patients of rheumatoid arthritis, according to a new study.

The study on the safety of biologic therapies in older patients with inflammatory diseases found that older users of biologic agents are at increased risk of infections compared with younger patients receiving these agents or older patients not receiving them.

Results of the systematic review and meta-analysis are published in the journal Clinical Gastroenterology and Hepatology.

Management of immune-mediated inflammatory diseases often requires lifelong immunosuppression. Increasing numbers of older patients have inflammatory diseases and are particularly vulnerable to risks of immune suppressive therapies—particularly infections and malignancies.

In order to assess the safety of biologic agents in older patients, Ashwin N. Ananthakrishnan, Associate Professor of Medicine Division of Gastroenterology, Massachusetts General Hospital, Boston, and associate Nienke Z. Borren utilized PubMed/Medline and Embase to search for studies conducted in older patients with inflammatory bowel disease, rheumatoid arthritis, or psoriasis.

“Included studies provided information on patients who began receiving therapy with a biologic agent when they were older than 60 years and a control population (either younger users of biologics or older patients who did not use biologics)," explained the authors. They extracted data on overall pooled rates of infections, malignancy, as well as mortality, and calculated pooled odds ratios (ORs).

The meta-analysis included 14 studies with 4719 older biologic agent users, 13,305 younger biologic agent users, and 3961 older non-biologic agent users.

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Key Findings:

• The pooled prevalence of infections in older and younger users of biologics was 13% and 6% respectively, yielding a pooled random effects odds ratio of 2.28 (95% CI, 1.57–3.31).


• A significant increase in the risk of malignancy was also observed for older users of biologics compared to younger users (OR: 3.07; 95% CI: 1.98–4.62).


• The risk of infection was 3 times more likely for older biologic users compared with older patients who did not take biologics (OR: 3.60; 95% CI: 1.62–8.01).


• No significant difference was observed in the risk of malignancy (OR: 0.54; 95% CI: 0.28, 1.05) or death (OR: 1.52; 95% CI: 0.44, 5.28) between the older biologic user group and older non-biologic user group.

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“Biologic therapy in older patients should be done with caution and in combination with minimizing risks, particularly of preventable infections through appropriate vaccination,” the study authors concluded, adding that large, prospective cohort studies are needed to examine the safety of biologic therapy in older patients with immune-mediated diseases.

For further reference log on to https://www.cghjournal.org/article/S1542-3565(19)30005-9/pdf