Background/Purpose: to investigate the potential relationship between the number of comorbidities at initiation of biotherapy and the occurrence of a severe infection or recurrent infections under biologic agent in rheumatoid arthritis (RA).

Methods: This was a monocentric and retrospective study conducted from 2001 to 2011. Population characteristics, number and nature of comorbidities and treatments were collected at baseline. The occurrence of severe infections leading to hospitalization or life threatening, as well as that of recurrent infections (> 4 per year) was collected during a 2 years-follow-up period after the introduction of an anti-TNF biologic agent or a non anti-TNF biotherapy in RA.

Results: 554 RA (70% women) were assessed during this 2 years follow up period. Mean age and RA duration were respectively at 64.1 (+/-13.8) years and at 15.2 (+/-10.4) years. 78% of patients were a rheumatoid factor or anti-CCP positive. The mean Disease Activity Score of C-Reactive protein (DAS 28 CRP) was 4.1. X-rays showed structural damage in 65.5% of cases. The mean dose of prednisone was 6.66 mg/l. 75.4% of patients received methorexate (mean dose: 10.5mg/week). Biological agents were prescribed as follows: abatacept (3.8%), adalimumab (20.6%), anakinra (7.8%), certolizumab (0.36%), etanercept (37.5%), infliximab (25.3%), rituximab (3.2%) and tocilizumab (1.6%). At 1 year, the therapeutic maintenance was 91.3%. In this population, 31.5% had no comorbidity, 27.4% had 1 comorbidity, 19.35% had 2 comorbidities and 21.7% had more than 2 comorbidities. The occurrence of recurrent infections during the 24^th months was 5.6% whereas the occurrence of a severe infection was 3.8%. After adjustment (age, corticosteroid and DAS 28 CRP), there was a significant correlation between the number of comorbidities (more than 2 comorbidities) and the occurrence of severe infections. The number of comorbidities was not correlated with the occurrence of repeated infections. The Rabbit score predicted the risk of developing a severe infection of the order of 3.5%. Certain types of comorbidities were linked to the occurrence of severe or recurrent infections.

Conclusion: The presence of more than 2 comorbidities is significantly related to the occurrence of a severe infection during the 24 months following the initiation of a biological agent.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-comorbidities-on-the-occurrence-of-infections-in-rheumatoid-arthritis-treated-by-biologic-agents/