OP0266 RISK OF HOSPITALIZED INFECTION IN PATIENTS WITH CHRONIC INFLAMMATORY ARTHRITIS TREATED WITH BIOLOGICAL DRUGS – A MATCHED COHORT STUDY
Authors: Simon Krabbe, Kathrine L. Grøn, Bente Glintborg, Frank Mehnert, Dorte E. Jarbøl, Mikkel Ǿstergaard, Merete L. Hetland
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) treated with biological drugs (bDMARDs) have increased risk of hospitalized infection (i.e. infection causing admission to hospital) compared to the general population. Since patients with RA, axSpA and PsA have different age distributions, and age is an important predictor for infection, we found it of interest to quantify the excess burden of hospitalized infection in patients with inflammatory arthritis treated with bDMARDs compared to the general population and to investigate whether risk depended on age and diagnosis. <h3>Objectives:</h3> To compare the risk of hospitalized infection in bio-naïve patients with inflammatory arthritis, who started treatment with a bDMARD with that of the general population, and to explore how this risk was influenced by age and diagnosis. <h3>Methods:</h3> Matched cohort study based on data from The Danish Rheumatology Register (DANBIO) linked with The Danish National Patient Register and The Danish National Prescription Register. Patients with a diagnosis of RA, PsA or axSpA in DANBIO initiating first bDMARD January 2006-December 2016 were included. For each patient, 10 controls from the general population, matched by age, sex, postal code and date were obtained. Infection risk in patients and matched controls were compared in analyses stratified by age and diagnosis, with Cox proportional hazards models accounting for matching. Follow-up time was 12 months irrespective of whether treatment was continued or changed during follow-up. Clinicaltrials.gov: NCT03496831. <h3>Results:</h3> In total, 11,372 patients and 113,715 controls were included. Overall, hospitalized infection was observed during follow-up in 4.6% of patients and 1.3% of controls; hazard ratio 3.7 (95% confidence interval (CI): 3.4-4.1). The absolute risk was highest in RA patients, followed by PsA, axSpA and controls (unadjusted comparison). When stratified by age, the absolute risk increased with age, but was largely similar across diagnoses (Figure). In the stratum ≥60 years, RA patients appeared to have higher risk than axSpA patients, but the subgroup of axSpA patients ≥60 years was small. <h3>Conclusion:</h3> The risk of hospitalized infection during 12 months of follow-up was approximately four times higher in bio-naïve patients with inflammatory arthritis who started treatment with a biological drug (bDMARD) compared to matched controls from the general population. When stratified by age, the absolute risk was largely similar across the diagnoses RA, axSpA and PsA. Thus, attention to preventive strategies such as vaccination seems prudent in these patients, especially those ≥60 years of age.&nbsp; <h3>Disclosure of Interests:</h3> Simon Krabbe: None declared, Kathrine L. Grøn: None declared, Bente Glintborg Grant/research support from: Biogen, Pfizer, AbbVie, Frank Mehnert: None declared, Dorte E. Jarbøl: None declared, Mikkel Ǿstergaard Grant/research support from: Abbvie, Celgene, Centocor, Merck, Novartis, Consultant for: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen, Pfizer, Consultant for: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck, Samsung Bioepis&nbsp;