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TOPLINE
Patients with rheumatoid arthritis (RA) who currently used TNF inhibitors or interleukin-6 (IL-6) receptor inhibitors had higher rates of first-time bloodstream infections than those who had no current use of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).
METHODOLOGY
- Researchers conducted a nested case-control study using Danish health registries to evaluate the association between the use of b/tsDMARDs and the risk for bloodstream infections in patients with RA.
- The analysis included 4128 patients with RA (median age, 76 years; 63.3% women) who developed a first-time bloodstream infection between 2010 and 2024 and 20,582 matched control individuals with RA who were free of bloodstream infections on the matched date.
- The use of TNF inhibitors, abatacept, IL-6 receptor inhibitors, or JAK inhibitors within 180 days before the first positive blood culture was compared with no use of these therapies.
- The researchers also evaluated the influence of concomitant therapies and differences across drug classes and individual agents.
TAKEAWAY
- Compared with current non-users of b/tsDMARDs, rates of bloodstream infections were higher among users of TNF inhibitors (adjusted incidence rate ratio [aIRR], 1.23; 95% CI, 1.10-1.38) and IL-6 receptor inhibitors (aIRR, 1.38; 95% CI, 1.09-1.76). Users of abatacept and JAK inhibitors showed no significant difference.
- Among TNF inhibitors, golimumab and infliximab were associated with significantly higher rates of bloodstream infections (aIRR, 2.40 and 1.47, respectively). Among IL-6 receptor inhibitors, tocilizumab was associated with higher rates.
- Users of IL-6 receptor inhibitors had a 42% higher rate of bloodstream infections than users of TNF inhibitors, whereas users of JAK inhibitors had a similar rate.
- Among users of TNF inhibitors, concomitant use of oral glucocorticoids was associated with higher rates of bloodstream infections than monotherapy, with a similar pattern observed among users of IL-6 receptor inhibitors.
IN PRACTICE
"Concomitant glucocorticoid use was associated with substantially higher rates among TNFi [TNF inhibitor] and IL-6Ri [IL-6 receptor inhibitor] users, underscoring the importance of minimising glucocorticoid exposure when possible," the authors of the study wrote.
SOURCE
The study was led by Caecilie Leding, Copenhagen University Hospital-Amager and Hvidovre, Copenhagen, Denmark. It was published online on October 1, 2026, in Arthritis Research & Therapy.
LIMITATIONS
The observational design did not establish causality and may have residual confounding. Intravenous and subcutaneous administration could not be distinguished. The study included both incident and prevalent users rather than strict new users.
DISCLOSURES
This study did not receive any specific funding. Some authors reported receiving grants, speaker honoraria, or research support and having other ties with various pharmaceutical companies. Detailed disclosures are available in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
