Background/Purpose:

Psoriatic arthritis (PsA) is an inflammatory condition of peripheral joints. If left untreated, it can lead to significant pain and joint deformity. Its treatment has undergone a revolution with the advent of TNF inhibitors and non-TNF biologics. Generally, these agents are well tolerated but due to their immunosuppressive properties there has been concerns for the increased risk of infections. The aim of this study was to estimate the risk of serious infections among patients with active PsA who are receiving either TNF inhibitors or non-TNF biologics.

Methods:

We conducted a systematic review and random-effects network meta-analysis of randomized clinical trials in STATA 15.1 assessing the occurrence of serious infections with the use of TNF inhibitors (etanercept, adalimumab, infliximab, certolizumab pegol, golimumab) and non-TNF biologics (apremilast, secukinumab, ixekizumab, brodalumab, ustekinumab, abatacept, tofacitinib, guselkumab, rituximab, tildrakizumab) in adult patients with PsA. We used random effects model to estimate the pooled odds ratios (ORs) and 95% confidence interval (CI). Serious infections in included trials were defined as those requiring hospitalization or discontinuation of therapy. Studies from five databases: PubMed, EMBASE, Cochrane, Web of Science and Clinicaltrials.gov databases were included from date of inception to June 4, 2018. The risk of bias of each study was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool for clinical trials.

Results:

2,052 citations were identified and on reviewing full-text papers 16 randomized clinical trials (n=4705) met our inclusion criteria. Based on 12 to 24-week placebo-controlled follow-up data, we identified seven trials using TNF inhibitors (infliximab, adalimumab, certolizumab and golimumab) and 9 trials using non-TNF biologics (apremilast, secukinumab, ixekizumab, bordalumab, ustekinumab, abatacept, tofacitinib). There was no statistically significant difference in odds ratio of serious infection between TNF inhibitors and non-TNF biologics. Overall, ustekinomab had lowest odds of serious infections (0.17, 95% CI: 0.01-4.1) followed by golimumab (0.23 95% CI: 0.06-0.92) and apremilast (0.50, 95% CI:0.07-3.50). Highest rate of serious infection was observed with inflixmab (OR 2.95, 95% CI:0.30-28.16).

Conclusion:

TNF inhibitors were not found to confer a higher risk of serious infection than non-TNF biologics. These results provide a better understanding of the risk of serious infection from psoriatic arthritis pharmacotherapy in patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/serious-infections-among-psoriatic-arthritis-patients-taking-tnf-inhibitors-versus-non-tnf-biologics-a-systematic-review-and-network-meta-analysis/