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26-11-2018 | Rheumatology | News | Article

Disease subtype, treatment choice may impact infection risk in JIA patients

medwireNews: Among biologic-treated patients with juvenile idiopathic arthritis (JIA), infection risk may differ according to disease subtype and the biologic agent used, researchers report.

The study included 307 JIA patients aged an average of 6.2 years at diagnosis and 9.0 years at the time of starting biologic treatment. At baseline, patients had been taking biologics – most commonly etanercept (61.6%), followed by adalimumab (19.5%), anakinra (7.2%), tocilizumab (4.2%), canakinumab (3.9%), and infliximab (3.6%) – for an average of 42.1 months.

Over 1 year of follow-up, 57% of participants developed an infection, including 157 upper respiratory tract infections and 40 acute tonsillopharyngitis infections. Three serious infections requiring hospitalization occurred over the study period, including pneumonia and pleural effusion in one patient and pneumonia in another, both of whom were treated with anakinra.

Ozgur Kasapcopur (Istanbul University, Turkey) and colleagues report in Clinical Rheumatology that infection rates were highest among the 52 patients with systemic JIA and lowest among the 42 with enthesitis-related arthritis, at 84.6% and 39.1%, respectively.

A total of 70.0% of the 10 patients with juvenile psoriatic arthritis developed infection, and rates ranged from 52.9% to 55.6% in those with oligoarticular (n=100), seropositive polyarticular (n=18), or seronegative polyarticular (n=85) JIA.

When comparing the different biologic agents, Kasapcopur and team found that infection rates were highest, at 90.0%, among the infliximab-treated patients, although there were only 11 patients in this group. Infection rates were lowest among the 189 individuals treated with etanercept, at 46.6%, and patients in the adalimumab, anakinra, canakinumab, and tocilizumab groups had infection rates of 67.8%, 72.7%, 83.3%, and 84.6%, respectively.

The researchers acknowledge a number of limitations of their study, including the lack of comparison between patients treated with conventional versus biologic DMARDs, and the “short follow-up period.”

They add that cases of tuberculosis and fungal infection did not occur over the duration of the study, but note that longer follow-up may be required to elucidate the risk for these infections associated with the different disease subtypes and biologic treatments.

And the team concludes that biologic agents have a favorable safety profile in JIA patients who can be monitored closely for infection.

By Claire Barnard

medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group