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Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis

Immunomodulatory therapy for rheumatoid arthritis (RA) carries risk for infectious complications. Understanding the risks of different therapeutic options is essential for making treatment decisions and appropriately monitoring patients. This review examines data on the risks for serious infections...

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Autores principales: Riley, Thomas R, George, Michael D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893655/
https://www.ncbi.nlm.nih.gov/pubmed/33597206
http://dx.doi.org/10.1136/rmdopen-2020-001235
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author Riley, Thomas R
George, Michael D
author_facet Riley, Thomas R
George, Michael D
author_sort Riley, Thomas R
collection PubMed
description Immunomodulatory therapy for rheumatoid arthritis (RA) carries risk for infectious complications. Understanding the risks of different therapeutic options is essential for making treatment decisions and appropriately monitoring patients. This review examines data on the risks for serious infections and other key infections of interest for the major classes of agents in use for RA: glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (DMARDs), biologics and Janus kinase (JAK) inhibitors. Conventional synthetic DMARDs have an excellent safety profile with recent data available supporting the relative safety of methotrexate. Tumour necrosis factor (TNF) inhibitors are associated with an increase in the risk of serious infections. Risk with other biological agents and with JAK inhibitors varies somewhat but overall appears similar to that of TNF inhibitors, with JAK inhibitors also associated with a greater risk of herpes zoster. Glucocorticoids have a dose-dependent effect on serious infection risk—at higher doses risk of infection with glucocorticoids is substantially greater than with other immunomodulatory therapies, and even low-dose therapy carries a risk of infection that appears to be similar to that of biological therapies.
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spelling pubmed-78936552021-03-03 Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis Riley, Thomas R George, Michael D RMD Open Rheumatoid Arthritis Immunomodulatory therapy for rheumatoid arthritis (RA) carries risk for infectious complications. Understanding the risks of different therapeutic options is essential for making treatment decisions and appropriately monitoring patients. This review examines data on the risks for serious infections and other key infections of interest for the major classes of agents in use for RA: glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (DMARDs), biologics and Janus kinase (JAK) inhibitors. Conventional synthetic DMARDs have an excellent safety profile with recent data available supporting the relative safety of methotrexate. Tumour necrosis factor (TNF) inhibitors are associated with an increase in the risk of serious infections. Risk with other biological agents and with JAK inhibitors varies somewhat but overall appears similar to that of TNF inhibitors, with JAK inhibitors also associated with a greater risk of herpes zoster. Glucocorticoids have a dose-dependent effect on serious infection risk—at higher doses risk of infection with glucocorticoids is substantially greater than with other immunomodulatory therapies, and even low-dose therapy carries a risk of infection that appears to be similar to that of biological therapies. BMJ Publishing Group 2021-02-17 /pmc/articles/PMC7893655/ /pubmed/33597206 http://dx.doi.org/10.1136/rmdopen-2020-001235 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Rheumatoid Arthritis
Riley, Thomas R
George, Michael D
Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis
title Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis
title_full Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis
title_fullStr Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis
title_full_unstemmed Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis
title_short Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis
title_sort risk for infections with glucocorticoids and dmards in patients with rheumatoid arthritis
topic Rheumatoid Arthritis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893655/
https://www.ncbi.nlm.nih.gov/pubmed/33597206
http://dx.doi.org/10.1136/rmdopen-2020-001235
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