title: Risk of infection with biologic antirheumatic therapies in patients with rheumatoid arthritis.
abstract: There are currently 10 licensed biologic therapies for the treatment of rheumatoid arthritis in 2014. In this article, we review the risk of serious infection (SI) for biologic therapies. This risk has been closely studied over the last 15 years within randomised controlled trials, long-term extension studies and observational drug registers, especially for the first three antitumour necrosis factor (TNF) drugs, namely infliximab, etanercept and adalimumab. The risk of SI with the newer biologics rituximab, tocilizumab, abatacept and tofacitinib is also reviewed, although further data from long-term observational studies are awaited. Beyond all-site SI, we review the risk of tuberculosis, other opportunistic infections and herpes zoster, and the effect of screening on TB rates. Lastly, we review emerging opportunities for stratifying the risk. Patients can be risk-stratified based on both modifiable and non-modifiable patient characteristics such as age, co-morbidity, glucocorticoid use, functional status and recent previous SI.
authors.affiliation: Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: manjari_lahiri@nuhs.edu.sg.
authors.forename: Manjari
authors.initials: M
authors.lastname: Lahiri
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. Electronic address: will.dixon@manchester.ac.uk.
authors.forename: William G
authors.initials: WG
authors.lastname: Dixon
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001691:Biological Therapy / Q000009:adverse effects*; D006801:Humans; D007239:Infections / Q000209:etiology*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents
keywords: Biological therapy; Infection; Rheumatoid arthritis