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• W2158721825 abstract "Biologic agents in rheumatoid arthritis are associated with a significant risk of opportunistic infections, especially tuberculosis and herpesvirus-related infections, especially in long-lasting disease. There is no convincing evidence for increased risk of fungal infections or Pneumocystis jirovecii pneumonia. Objective. Biologic agents are increasingly used to treat patients with rheumatoid arthritis (RA). We aimed to review their association with opportunistic infections (OIs), including fungal, viral (with a focus on herpesvirus-related infections), tuberculosis and other mycobacterial infections. Methods. We searched PubMed and EMBASE through June 24, 2013, and complemented the search with the reference lists of eligible articles. The analysis included randomized trials on RA that compared any approved biologic agent with controls and reported the risk of OIs. Results. A total of 70 trials that included 32 504 patients (21 916 patients receiving biologic agents and 10 588 receiving placebo) were deemed eligible. Biologic agents increased the risk of OIs (pooled Peto odds ratio [OR], 1.79; 95% confidence interval [CI], 1.17–2.74; I2 = 3%), resulting in 1.7 excess infections per 1000 patients treated (number needed to harm, 582). A significant risk was noted for mycobacterial (OR, 3.73; 95% CI, 1.72–8.13; I2 = 0), and viral (OR, 1.91; 95% CI, 1.02–3.58; I2 = 0) infections. Interestingly, no significant differences were found for invasive and superficial fungal infections (1.31; 95% CI, .46–3.72), invasive fungal infections (2.85; .68–11.91), P. jirovecii pneumonia (1.77; .42–7.47), varicella-zoster virus (1.51; .71–3.22), as well as overall mortality attributed to OIs (1.91; .29–12.64). Conclusions. Among patients with RA, biologic agents are associated with a small but significant risk of specific OIs. This increase is associated with mycobacterial diseases and does not seem to affect overall mortality. Because OIs are a relatively rare complication of biologic agents, large registries are needed to identify the exact effect in different OIs and to compare the different biologic agents." @default.
• W2158721825 created "2016-06-24" @default.
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• W2158721825 creator A5015388088 @default.
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• W2158721825 date "2014-03-18" @default.
• W2158721825 modified "2023-10-06" @default.
• W2158721825 title "Biologic Therapies in Rheumatoid Arthritis and the Risk of Opportunistic Infections: A Meta-analysis" @default.
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• W2158721825 doi "https://doi.org/10.1093/cid/ciu185" @default.
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