title: Biologic therapies and infections in the daily practice of three Italian rheumatologic units: a prospective, observational study.
abstract: Since the introduction of biologics, many concerns about the increased risk of infections have been reported and, to date, the real impact of infections on the daily practice in the rheumatologic centers is still largely unknown. In this work, we evaluated the infection rates associated with the use of biologics in a large cohort of patients. A prospective study, between January 2010 and December 2013, enrolling 731 rheumatic patients, was performed. Demographic and disease characteristics, therapies, comorbidities, and infectious events were recorded and statistically analyzed by multivariate analysis. Two-hundred thirty-five infectious episodes were observed in 28.4 % of patients. About total infections, bacteria were identified in 70.6 % of total cases and viruses in 18.3 %. The most common site of not-serious infection was the urinary tract. Duration of disease, longer follow-up, concomitant steroid therapy, and comorbidities were significantly associated with not-serious infection. In our cohort, 17 episodes fulfilled the criteria of serious infection and occurred in 17 different patients (2.3 %), the majority involving the lower respiratory tract. Serious infections were associated with the beginning of biologics in older age. Our prospective, observational study showed that, in daily practice, a lesser rate of serious as well as not-serious infections may be observed in rheumatic patients treated with biologics than those reported in previous papers. The most common sites of not-serious infections are both the urinary and the respiratory tracts, and for serious infections, the respiratory tract. When pathogens were isolated, we did not find any multidrug-resistant organism.
authors: Rheumatology Division, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, PO Box 67100, L'Aquila, Italy. paola.cipriani@cc.univaq.it.
authors: Paola
authors: P
authors: Cipriani
authors: Rheumatology Division, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, PO Box 67100, L'Aquila, Italy.
authors: Onorina
authors: O
authors: Berardicurti
authors: Division of Medical Statistic Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
authors: Francesco
authors: F
authors: Masedu
authors: Rheumatologic Clinic, University of Foggia, Foggia, Italy.
authors: Francesca
authors: F
authors: D'Onofrio
authors: Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University, Rome, Italy.
authors: Luca
authors: L
authors: Navarini
authors: Rheumatology Division, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, PO Box 67100, L'Aquila, Italy.
authors: Piero
authors: P
authors: Ruscitti
authors: Rheumatologic Clinic, University of Foggia, Foggia, Italy.
authors: Nicola
authors: N
authors: Maruotti
authors: Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University, Rome, Italy.
authors: Domenico Paolo Emanuele
authors: DP
authors: Margiotta
authors: Rheumatology Division, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, PO Box 67100, L'Aquila, Italy.
authors: Vasiliki
authors: V
authors: Liakouli
authors: Rheumatology Division, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, PO Box 67100, L'Aquila, Italy.
authors: Paola
authors: P
authors: Di Benedetto
authors: Rheumatology Division, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, PO Box 67100, L'Aquila, Italy.
authors: Francesco
authors: F
authors: Carubbi
authors: Division of Medical Statistic Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
authors: Marco
authors: M
authors: Valenti
authors: Rheumatologic Clinic, University of Foggia, Foggia, Italy.
authors: Francesco Paolo
authors: FP
authors: Cantatore
authors: Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University, Rome, Italy.
authors: Antonella
authors: A
authors: Afeltra
authors: Rheumatology Division, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, PO Box 67100, L'Aquila, Italy.
authors: Roberto
authors: R
authors: Giacomelli
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000150:complications* / Q000188:drug therapy; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012219:Rheumatology / Q000379:methods*; D012307:Risk Factors; D025242:Spondylarthropathies / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha
keywords: Biological therapies; Infection and arthritis; Rheumatoid arthritis; Serious infection; Spondyloarthropathies; TNF inhibitor