title: Severe infection in patients with rheumatoid arthritis taking anakinra, rituximab, or abatacept: a systematic review of observational studies.
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.
authors.affiliation: Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas (INI), Comissão de Controle de Infecção Hospitalar, Rio de Janeiro, RJ, Brazil.
authors.forename: Vanderlea Poeys
authors.initials: VP
authors.lastname: Cabral
authors.affiliation: Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas (INI), Laboratório de Epidemiologia Clínica, Rio de Janeiro, RJ, Brazil. Electronic address: carlosandrade07@gmail.com.
authors.forename: Carlos Augusto Ferreira de
authors.initials: CA
authors.lastname: Andrade
authors.affiliation: Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas (INI), Laboratório de Epidemiologia Clínica, Rio de Janeiro, RJ, Brazil.
authors.forename: Sonia Regina Lambert
authors.initials: SR
authors.lastname: Passos
authors.affiliation: Fundação Oswaldo Cruz (Fiocruz), Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Rio de Janeiro, RJ, Brazil.
authors.forename: Maria de Fátima Moreira
authors.initials: MF
authors.lastname: Martins
authors.affiliation: Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas (INI), Laboratório de Epidemiologia Clínica, Rio de Janeiro, RJ, Brazil.
authors.forename: Yara Hahr Marques
authors.initials: YH
authors.lastname: Hökerberg
mesh_terms: D000069594:Abatacept; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use; D053590:Interleukin 1 Receptor Antagonist Protein; D000069283:Rituximab
chemical_list: D018501:Antirheumatic Agents; D007155:Immunologic Factors; D053590:Interleukin 1 Receptor Antagonist Protein; D000069283:Rituximab; D000069594:Abatacept
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