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Review
. 2016 Nov-Dec;56(6):543-550.
doi: 10.1016/j.rbre.2016.10.001. Epub 2016 Oct 27.

Severe infection in patients with rheumatoid arthritis taking anakinra, rituximab, or abatacept: a systematic review of observational studies

[Article in English, Portuguese]
Vanderlea Poeys Cabral  1 , Carlos Augusto Ferreira de Andrade  2 , Sonia Regina Lambert Passos  3 , Maria de Fátima Moreira Martins  4 , Yara Hahr Marques Hökerberg  3
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Free article
Review

Severe infection in patients with rheumatoid arthritis taking anakinra, rituximab, or abatacept: a systematic review of observational studies

[Article in English, Portuguese]
Vanderlea Poeys Cabral et al. Rev Bras Reumatol Engl Ed. 2016 Nov-Dec.
Free article

Abstract

A question is raised about an increased risk of severe infection from the use of biological drugs in patients with rheumatoid arthritis. This systematic review of observational studies aimed at assessing the risk of severe infection associated with the use of anakinra, rituximab, and abatacept in patients with rheumatoid arthritis. The following databases were searched: PubMed, Science Direct, Scopus, Web of Knowledge, Scirus, Cochrane, Exerpta Medica Database, Scielo, and Lilacs up to July 2010. Severe infections were defined as those life-threatening ones in need of the use of parenteral antibiotics or of hospitalization. Longitudinal observational studies were selected without language restriction, involving adult patients diagnosed with rheumatoid arthritis and who used anakinra, rituximab, or abatacept. In four studies related to anakinra, 129 (5.1%) severe infections were related in 2896 patients, of which three died. With respect to rituximab, two studies reported 72 (5.9%) severe infections in 1224 patients, of which two died. Abatacept was evaluated in only one study in which 25 (2.4%) severe infections were reported in 1046 patients. The main site of infection for these three drugs was the respiratory tract. One possible explanation for the high frequency of severe infections associated with anakinra may be the longer follow-up time in the selected studies. The high frequency of severe infections associated with rituximab could be credited to the less strict inclusion criteria for the patients studied. Therefore, infection monitoring should be cautious in patients with rheumatoid arthritis in use of these three drugs.

Keywords: Anti-rheumatic drugs/adverse effects; Antirreumáticos/efeitos adversos; Artrite reumatoide/terapia; Biological therapy/adverse effects; Infection; Infecção; Review of literature as topic; Revisão de literatura como assunto; Rheumatoid arthritis/therapy; Terapia biológica/efeitos adversos.

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