Impact of tapering targeted therapies (bDMARDs or JAKis) on the risk of serious infections and adverse events of special interest in patients with rheumatoid arthritis or spondyloarthritis : a systematic analysis of the literature and meta-analysis
Vinson, Dorothee (CHU Sainte Marguerite. Rheumatology Department)
Molet-Benhamou, Luc (Hôpital Purpan. Rheumatology Department)
Degboé, Yannick (CPTP. INSERM U1043)
den Broeder, Alfons (Sint Maartenskliniek. Department of Rheumatology)
Ibrahim, Fowzia (King's College London. Centre for Rheumatic Diseases)
Pontes García, Caridad (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Westhovens, Rene (University Hospitals Leuven (Bèlgica))
Závada, Jakub (Charles University. First Faculty of Medicine, Institute of Rheumatology and Department of Rheumatology)
Pham, Thao (CHU Sainte Marguerite. Rheumatology Department)
Barnetche, Thomas (Pellegrin Hospital. Rheumatology Department)
Constantin, Arnaud (Hôpital Purpan. Rheumatology Department)
Ruyssen-Witrand, Adeline (Hôpital Purpan. Rheumatology Department)
Universitat Autònoma de Barcelona. Departament de Farmacologia, de Terapèutica i de Toxicologia

Date:	2020
Abstract:	To systematically review the impact of tapering targeted therapies (bDMARDs or JAKis) on the risk of serious infections and severe adverse events (SAEs) in patients with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) in remission or low disease activity (LDA) state. A meta-analysis based on a systematic review of PubMed, Embase, Cochrane, until August 2019, as well as relevant databases of international conferences, was used to evaluate the risk difference (RD) at 95% confidence interval (95% CI) of incidence density of serious infections, SAEs, malignancies, cardiovascular adverse events (CV AEs), or deaths after tapering (dose reduction or spacing) compared to continuation of targeted therapies. Of the 1957 studies initially identified, 13 controlled trials (9 RA and 4 SpA trials) were included in the meta-analysis. 1174 patient-years were studied in the tapering group (TG) versus 1086 in the usual care group (UC). There were 1. 7/100 patient-year (p-y) serious infections in TG versus 2. 6/100 p-y in UC (RD (95% CI) 0. 01 (0. 00 to 0. 02), p = 0. 13) and 7. 4/100 p-y SAEs in TG versus 6. 7/100 p-y in UC (RD 0. 00 (− 0. 02 to 0. 02), p = 0. 82). The risk of malignancies, CV AEs, or deaths did not differ between the tapering and the usual care groups. Subgroup analysis (RA and SpA) detected no significant differences between the two groups. We could not show significant impact of tapering bDMARD or JAKi over continuation concerning the risk of serious infections, SAEs, malignancies, CV AEs, or deaths in RA and SpA patients in remission or LDA state.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Rheumatoid arthritis ; Spondyloarthritis ; Biological therapies ; DMARDs ; Infection bacteria ; Viruses infection ; Systematic review
Published in:	Arthritis research & therapy, Vol. 22 (april 2020) , ISSN 1478-6362

DOI: 10.1186/s13075-020-02188-x
PMID: 32349791

11 p, 1.6 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Articles > Research articles
Articles > Published articles