Background—Patients with rheumatoid arthritis (RA) are at increased risk of infections after arthroplasty, yet risks of specific biologic medications are unknown. Objectives—To compare the risk of post-operative infection between different biologics and to evaluate the risk associated with glucocorticoids. Design—Retrospective cohort. Setting—Medicare and Truven MarketScan® administrative data January 2006-September 2015. Patients—Adults with RA undergoing elective inpatient primary or revision total knee or hip arthroplasty with recent infusion or prescription for abatacept, adalimumab, etanercept, infliximab, rituximab, or tocilizumab before surgery. Measurements—Propensity adjusted analyses using inverse probability weights evaluated comparative risk of 30-day hospitalized infection and 1-year prosthetic joint infection (PJI) between biologics or glucocorticoid doses. Secondary analyses evaluated non-urinary hospitalized infection and 30-day readmission. Results—We identified 10,923 surgeries among 9,911 biologic-treated patients. Outcomes were similar in patients treated with different biologics. Compared to an 8.16% risk of hospitalized infection and 2.14% 1-year cumulative incidence of PJI with abatacept, predicted risk from propensity-weighted models ranged from 6.87% (5.30–8.90) with adalimumab to 8.90% (5.70–13.52) with rituximab for hospitalized infection and from 0.35% (0.11–1.12) with rituximab to 3.67% (1.69–7.88) with tocilizumab for PJI. Glucocorticoids were associated with a dose-dependent increase in post-operative risk for all outcomes. Compared to patients not receiving glucocorticoids, predicted risk from propensity-weighted models for >10mg/day glucocorticoids was 13.25% (9.72–17.81) vs. 6.78% for hospitalized infection and 3.83% (2.13–6.87) vs. 2.09% for 1-year cumulative incidence of PJI. Limitations—Potential for residual confounding, small sample size for rituximab and tocilizumab. Conclusion—Risk of hospitalized infection, prosthetic joint infection, and readmission after arthroplasty was similar across biologics. In contrast, glucocorticoid use, especially > 10mg/day, was associated with greater risk of adverse outcomes. Primary funding sources—Rheumatology Research Foundation, National Institutes of Health, and Bristol-Myers Squibb.
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Background—Patients with rheumatoid arthritis (RA) are at increased risk of infections after arthroplasty, yet risks of specific biologic medications are unknown. Objectives—To compare the risk of post-operative infection between different biologics and to evaluate the risk associated with glucocorticoids. Design—Retrospective cohort. Setting—Medicare and Truven MarketScan® administrative data January 2006-September 2015. Patients—Adults with RA undergoing elective inpatient primary or revision total knee or hip arthroplasty with recent infusion or prescription for abatacept, adalimumab, etanercept, infliximab, rituximab, or tocilizumab before surgery. Measurements—Propensity adjusted analyses using inverse probability weights evaluated comparative risk of 30-day hospitalized infection and 1-year prosthetic joint infection (PJI) between biologics or glucocorticoid doses. Secondary analyses evaluated non-urinary hospitalized infection and 30-day readmission. Results—We identified 10,923 surgeries among 9,911 biologic-treated patients. Outcomes were similar in patients treated with different biologics. Compared to an 8.16% risk of hospitalized infection and 2.14% 1-year cumulative incidence of PJI with abatacept, predicted risk from propensity-weighted models ranged from 6.87% (5.30–8.90) with adalimumab to 8.90% (5.70–13.52) with rituximab for hospitalized infection and from 0.35% (0.11–1.12) with rituximab to 3.67% (1.69–7.88) with tocilizumab for PJI. Glucocorticoids were associated with a dose-dependent increase in post-operative risk for all outcomes. Compared to patients not receiving glucocorticoids, predicted risk from propensity-weighted models for >10mg/day glucocorticoids was 13.25% (9.72–17.81) vs. 6.78% for hospitalized infection and 3.83% (2.13–6.87) vs. 2.09% for 1-year cumulative incidence of PJI. Limitations—Potential for residual confounding, small sample size for rituximab and tocilizumab. Conclusion—Risk of hospitalized infection, prosthetic joint infection, and readmission after arthroplasty was similar across biologics. In contrast, glucocorticoid use, especially > 10mg/day, was associated with greater risk of adverse outcomes. Primary funding sources—Rheumatology Research Foundation, National Institutes of Health, and Bristol-Myers Squibb.
Copyright remains with the authors and publisher.