High rate of serious infection in juvenile idiopathic arthritis patients under biologic therapy in a real-life setting

Abstract

Objectives: To assess the rate of serious and/or opportunistic infections in juvenile idiopathic arthritis (JIA) patients from a single tertiary center under biologic therapy and to identify possible risk factors associated to these complications.

Methods: A total of 107 JIA patients followed at the biologic therapy center of our tertiary university hospital using a standardized electronic database protocol including demographic data, clinical and laboratorial findings and treatment at baseline and at the moment of infection. Opportunistic infections included tuberculosis, herpes zoster and systemic mycosis.

Results: A total of 398 patient-yrs(py) were included. The median time of biologic exposure was 3.0 years (0.15–11.5). We observed 35 serious/opportunistic infectious events in 27 (25%) patients: 31(88.6%) were serious infections and four (11.4%) opportunistic infections. Serious/opportunistic infections rates were 10.6/100py for ETN, 10.9/100py for ADA, 2.6/100py for ABA and 14.8/100py for TCZ. Comparison of 27 patients with and 80 without infection showed a higher frequency of systemic-onset JIA, lower age at biologic therapy initiation and a history of previous serious infection (p < .05) in the former group.

Conclusions: This study demonstrated a high rate of serious infections in JIA patients under biologic therapy in a real-life setting. Systemic-onset JIA, lower age at biologic therapy start and history of previous serious infections were important risk factors for these complications. Also, higher rates of severe infections comparing to the former studies was possibly due to elevated MTX doses in our patients.

Keywords:

• Juvenile idiopathic arthritis
• serious infection
• opportunistic infection
• biologic

Conflicts of interest

None.

Additional information

Funding

This study was supported by grants from Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP 2009/51897-5 and 2015/03756-4 to EB and FAPESP 2014/14806-0 to CAS) Conselho Nacional de Desenvolvimento Científico e Tecnologico (CNPq 303422/2015-7 to CAS and 305068/2014-8 to EB).