Abstract

The Hazard of Developing Adverse Reactions in Rheumatoid Arthritis Patients receiving Intravenous Biologics: A Survival Analysis

Objectives: Limited previous studies have investigated the hazard and time to develop Adverse Drug Reactions (ADRs) of Intravenous (IV) biological Disease-Modifying Antirheumatic Drugs (bDMARDs) in patients with Rheumatoid Arthritis (RA). This study aimed to investigate the hazard of using different IV originator bDMARDs in comparison to each other and to assess the survival of this hazard in RA patients with or without conventional synthetic Disease- Modifying Antirheumatic Drugs (csDMARDs). Methods: This is a single-centre retrospective cohort study at in Saudi Arabia, of adult RA patients receiving IV originator bDMARDs, including Tocilizumab (TCZ), Rituximab (RTX), Abatacept (ABA), and Infliximab (IFX), with or without conventional synthetic Disease-Modifying Antirheumatic Drugs (csDMARDs). Data extraction was between January 2019 to March 2020. The type and time to develop ADRs for each bDMARDs between 2015-2020 were noted. Results: A total of 129 were eligible for inclusion with 113 (87.6%) were females with a mean age of 54 (SD ± 13) years. Patients received TCZ (38.8%) RTX (38.8%), ABA (14.0%) and IFX (8.5%). A significant difference was observed in the ADR-free survival period among the included bDMARDs (p=0.01) with ABA as a reference group. RTX was associated with lower ADRs in 1500 days of follow-up compared with ABA (Hazard Ratios (HRs)=0.39, p=0.003), followed by TCZ (HR=0.45, p=0.012). This remained significant even after the adjustment for confounders. IFX had lower ADRs compared with ABA, but this result was statistically insignificant. Conclusion: There is significantly less hazard of developing ADRs while using IV bDMARDs, namely, TCZ and RTA, compared with ABA in RA patients.

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