If You Have RA and Are Worried About Infection, Abatacept Might Be a Better Pick Than Other Biologics

Biologic medications have been a game changer for people with rheumatoid arthritis (RA), since they not only treat symptoms like joint pain and swelling but actually stop or slow the disease process. The catch, however, is that many of them raise the risk of potentially dangerous infections like pneumonia and tuberculosis.

That’s true for a number of these drugs, but a new study finds that one type of biologic may be less likely to cause serious infection than other options.

Many RA patients take tumor necrosis factor (TNF) inhibitors for their first biologic. These drugs, which include adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade), work by blocking TNF, a chemical that promotes inflammation. Another kind of biologic, a selective co-stimulation modulator, instead works by preventing the immune system from overreacting. At the moment, the only biologic that works like this is abatacept (Orencia).

While TNF inhibitors and abatacept seems to control RA equally well, a new study finds that abatacept might have an edge because it’s linked to a lower risk of infections.

The new study, published in the journal Arthritis Care & Research, was conducted by researchers at Brigham and Women’s Hospital in Boston and funded by the manufacturer of abatacept (Bristol-Myers Squibb). Researchers relied on the Truven MarketScan database, which contains de-identified information about patients in all 50 states. They then homed in on 11,248 RA patients who started using abatacept and compared them against another 11,248 RA patients who used one of the three most popular TNF-inhibitors between 2006 and 2015.

The results indicated that people taking abatacept had a significantly lower risk of developing an infection that required them to be hospitalised. The study authors projected that 36.7 patients using abatacept would be hospitalized for infection over a period of 1,000 “person years,” compared to 47.4 patients taking a TNF inhibitor.

While people who used any of the three TNF inhibitors studied had a higher chance of infection (compared to abatacept), infliximab carried the greatest infection risk.

“In this large nationwide cohort of RA patients… we found a lower risk of any hospitalised infections associated with abatacept versus [TNF-inhibitors], particularly in comparison to infliximab, suggesting that RA patients with specific concerns about infections may benefit from use of abatacept” instead of a TNF-inhibitor, the authors concluded.

These findings don’t necessarily mean you should change your RA treatment regimen. Talk to your doctor if you don’t think your current medication is working well for you or you’re especially prone to infection.

Note: This information should never replace the information and advice from your treating doctors. It is meant to inform the discussion that you have with healthcare professionals, as well as others who play a role in your care and well-being.

CreakyJoints encourages everyone with inflammatory arthritis to talk to a rheumatologist about the finding the right treatment plan for them. These diseases can still cause underlying damage to your joints, bones, and certain organs even if some symptoms improve. Prescription medications are often at the core of treatment due to the strong evidence supporting their success.