Francisco Espinoza1,2, Pierre Le Blay3,4, Bernard Combe3,4. 1. From the Department of Rheumatology, Lapeyronie University Hospital, University of Montpellier, Montpellier, France; Department of Rheumatology, School of Medicine, Universidad de los Andes, Santiago, Chile. fespinoza@uandes.cl. 2. F. Espinoza, MD, Department of Rheumatology, Lapeyronie University Hospital, University of Montpellier and Department of Rheumatology, School of Medicine, Universidad de los Andes; P. Le Blay, MD, Department of Rheumatology, Lapeyronie University Hospital, University of Montpellier; B. Combe, MD, PhD, Department of Rheumatology, Lapeyronie University Hospital, University of Montpellier. fespinoza@uandes.cl. 3. From the Department of Rheumatology, Lapeyronie University Hospital, University of Montpellier, Montpellier, France; Department of Rheumatology, School of Medicine, Universidad de los Andes, Santiago, Chile. 4. F. Espinoza, MD, Department of Rheumatology, Lapeyronie University Hospital, University of Montpellier and Department of Rheumatology, School of Medicine, Universidad de los Andes; P. Le Blay, MD, Department of Rheumatology, Lapeyronie University Hospital, University of Montpellier; B. Combe, MD, PhD, Department of Rheumatology, Lapeyronie University Hospital, University of Montpellier.
Abstract
OBJECTIVE: To examine the rate, risks factors, and consequences of neutropenia induced by intravenous (IV) biologic disease-modifying antirheumatic drugs (bDMARD). METHODS: We conducted a retrospective cohort study in 499 patients with rheumatic diseases treated by IV abatacept (ABA), infliximab (IFX), or tocilizumab (TCZ). RESULTS: Rheumatoid arthritis (RA) was the most frequent diagnosis (72%). Fifty-two patients (10.4%) experienced at least 1 episode of neutropenia. No episodes of grade 4 neutropenia were documented. TCZ was more frequently related to neutropenia than ABA or IFX (18.6% vs 3.8% and 2.8%, respectively, p < 0.001). The following factors were identified as predictors of experiencing neutropenia with IV bDMARD: history of neutropenia with methotrexate (MTX; synthetic DMARD; OR 1.56, 95% CI 1.17-7.14), concomitant treatment by MTX (OR 1.21, 95% CI 1.01-2.64), and TCZ treatment (OR 2.72, 95% CI 1.53-9.05). Patients experiencing a TCZ-induced neutropenia did not show a higher risk of severe infections; however, this group had a shorter drug survival (9 mos vs 20 mos, p < 0.02) compared with TCZ patients without neutropenia. CONCLUSION: Among 3 different classes of IV bDMARD, TCZ is associated with the higher risk of neutropenia. No increased frequency of infection episodes was documented in this group.
OBJECTIVE: To examine the rate, risks factors, and consequences of neutropenia induced by intravenous (IV) biologic disease-modifying antirheumatic drugs (bDMARD). METHODS: We conducted a retrospective cohort study in 499 patients with rheumatic diseases treated by IV abatacept (ABA), infliximab (IFX), or tocilizumab (TCZ). RESULTS:Rheumatoid arthritis (RA) was the most frequent diagnosis (72%). Fifty-two patients (10.4%) experienced at least 1 episode of neutropenia. No episodes of grade 4 neutropenia were documented. TCZ was more frequently related to neutropenia than ABA or IFX (18.6% vs 3.8% and 2.8%, respectively, p < 0.001). The following factors were identified as predictors of experiencing neutropenia with IV bDMARD: history of neutropenia with methotrexate (MTX; synthetic DMARD; OR 1.56, 95% CI 1.17-7.14), concomitant treatment by MTX (OR 1.21, 95% CI 1.01-2.64), and TCZ treatment (OR 2.72, 95% CI 1.53-9.05). Patients experiencing a TCZ-induced neutropenia did not show a higher risk of severe infections; however, this group had a shorter drug survival (9 mos vs 20 mos, p < 0.02) compared with TCZpatients without neutropenia. CONCLUSION: Among 3 different classes of IV bDMARD, TCZ is associated with the higher risk of neutropenia. No increased frequency of infection episodes was documented in this group.
Authors: Samendra Karkhur; Murat Hasanreisoglu; Erin Vigil; Muhammad Sohail Halim; Muhammad Hassan; Carlos Plaza; Nam V Nguyen; Rubbia Afridi; Anh T Tran; Diana V Do; Yasir J Sepah; Quan Dong Nguyen Journal: J Ophthalmic Inflamm Infect Date: 2019-09-16