The treatment of autoimmune rheumatic diseases has undergone a sea change with the advent of biological therapy. The prevalence of infections caused by these medicines has shown mixed results. The goal of this research was to evaluate whether or not patients taking biological disease-modifying antirheumatic drugs (bDMARDs) experienced a different spectrum or severity of infections compared to those taking conventional disease-modifying antirheumatic drugs (cDMARDs). About 200 patients participated in this prospective observational study at a tertiary care hospital. Patients with evidence of infection who had been taking bDMARDs or cDMARDs for at least 6 weeks were included. Patients with a history of immunosuppression, those with severe comorbidities, and those receiving doses of prednisolone greater than 7.5 mg were not included. Mean ± SD and percentages were used to summarise the data. For testing linearity, researchers used Kolmogorov-Smirnov analysis, and for testing the significance of the difference between more than 2 parameters in parametric data, they used analysis of variance (ANOVA) followed by Tukey’s HSD test. Infections were most commonly associated with rheumatoid arthritis (58 patients, 29%) and systemic lupus erythematosus (37 patients, 18.5%). There were 135 patients taking cDMARDs (67.5%), and 65 took bDMARDs (32.5%). In 47 patients (or 34.8%), cDMARD-related infections were found in the respiratory system. Biologics were associated with a higher infection rate, and infliximab and etanercept recipients experienced infections differently than those treated with cDMARDs. Etanercept patients were more likely to experience infections and re-infections, though these were less severe than those experienced by patients taking conventional disease-modifying antirheumatic drugs (cDMARDs). Unvaccinated patients were found to have a significantly higher rate of reinfection. The authors of this study stress the importance of keeping in mind that the use of TNF-α inhibitors is correlated with elevated infection risk. More patients taking etanercept experience infections but tend to be milder than those taking cDMARDs. When it comes to avoiding secondary infections, vaccinations are crucial.

Source: journals.lww.com/jfmpc/Fulltext/2022/07000/Spectrum_of_infections_occurring_in_patients_of.30.aspx