Frailty tied to Adverse Events in RA Patients on Biologic and Targeted Synthetic DMARDs, finds study

In an Original Article published in Arthritis Care & Research, Singh et al. and colleagues concluded that Patients with a history of rheumatoid arthritis who are treated with biologic (b) or targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs) have an increased risk of adverse outcomes, with Frailty being a significant predictor.

Whether frailty status increases the risk of adverse outcomes in RA patients starting bDMARDs or tsDMARDs remains unclear.

The researchers used MarketScan data to identify new users of tumor necrosis factor inhibitors (TNFi), non-TNFi, bDMARDs, or Janus Kinase inhibitors (JAKi) for RA between 2008 and 2019. Patients' baseline frailty risk scores were calculated using a Claims-Based Frailty Index, and frailty status was defined as ≥0.2. The primary outcome was time to severe infection, with secondary outcomes including time-to-any infection and all-cause hospitalizations. Cox proportional hazards were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CI), and the significance of interaction terms between frailty status and drug class was assessed.

Important summary points are:

· 57,980 patients of mean age48.1 ± 10.1 were included.

· 83 % of patients started TNFi, 14 % started non-TNFi biologics, and 3% started JAKi.

· Among these, 3560, constituting 6%, were categorized as frail.

· Frailty was associated with a 50% increased risk of serious infections with aHR 1.5 and a 40% higher risk of inpatient admissions than non-frail patients among those who initiated TNFi.

· Frailty was also associated with a higher infection risk relative to non-frail patients among those on TNFi, non-TNFi or JAKi.

Concluding further, Frailty is a significant predictor for the risk of adverse outcomes among patients with RA treated with biologic b tsDMARDs.

Reference:

Singh, N et al. Frailty and risk of serious infections in patients with rheumatoid arthritis treated with biologic or targeted‐synthetic DMARDs. Arthritis Care & Research.