PT  - JOURNAL ARTICLE
AU  - Ajinkya Pawar
AU  - Rishi J Desai
AU  - Daniel H Solomon
AU  - Adrian J Santiago Ortiz
AU  - Sara Gale
AU  - Min Bao
AU  - Khaled Sarsour
AU  - Sebastian Schneeweiss
AU  - Seoyoung C Kim
TI  - Risk of serious infections in tocilizumab versus other biologic drugs in patients with rheumatoid arthritis: a multidatabase cohort study
AID  - 10.1136/annrheumdis-2018-214367
DP  - 2019 Apr 01
TA  - Annals of the Rheumatic Diseases
PG  - 456--464
VI  - 78
IP  - 4
4099  - http://ard.bmj.com/content/78/4/456.short
4100  - http://ard.bmj.com/content/78/4/456.full
SO  - Ann Rheum Dis2019 Apr 01; 78
AB  - Objective To investigate the rate of serious bacterial, viral or opportunistic infection in patients with rheumatoid arthritis (RA) starting tocilizumab (TCZ) versus tumour necrosis factor inhibitors (TNFi) or abatacept.Methods Using claims data from US Medicare from 2010 to 2015, and IMS and MarketScan from 2011 to 2015, we identified adults with RA who initiated TCZ or TNFi (primary comparator)/abatacept (secondary comparator) with prior use of ≥1 different biologic drug or tofacitinib. The primary outcome was hospitalised serious infection (SI), including bacterial, viral or opportunistic infection. To control for >70 confounders, TCZ initiators were propensity score (PS)-matched to TNFi or abatacept initiators. Database-specific HRs were combined by a meta-analysis.Results The primary cohort included 16 074 TCZ PS-matched to 33 109 TNFi initiators. The risk of composite SI was not different between TCZ and TNFi initiators (combined HR 1.05, 95% CI 0.95 to 1.16). However, TCZ was associated with an increased risk of serious bacterial infection (HR 1.19, 95% CI 1.07 to 1.33), skin and soft tissue infections (HR 2.38, 95% CI 1.47 to 3.86), and diverticulitis (HR 2.34, 95% CI 1.64 to 3.34) versus TNFi. An increased risk of composite SI, serious bacterial infection, diverticulitis, pneumonia/upper respiratory tract infection and septicaemia/bacteraemia was observed in TCZ versus abatacept users.Conclusions This large multidatabase cohort study found no difference in composite SI risk in patients with RA initiating TCZ versus TNFi after failing ≥1 biologic drug or tofacitinib. However, the risk of serious bacterial infection, skin and soft tissue infections, and diverticulitis was higher in TCZ versus TNFi initiators. The risk of composite SI was higher in TCZ initiators versus abatacept.