Risks for infections after arthroplasty similar across biologics
Various biologic medications used prior to total knee or hip arthroplasty demonstrate similar risks for hospitalized infection, prosthetic joint infection (PJI) and readmission after surgery, reports a study. In contrast, glucocorticoids, particularly with dosages >10 mg/d, yield a greater risk for adverse outcomes.
Overall, 10,923 surgical procedures were performed in 9,911 patients treated with biologics. Patients who received different biologics showed comparable outcomes.
Compared with a risk of 8.16 percent for hospitalized infection with abatacept, propensity-weighted models revealed a predicted risk ranging from 6.87 percent (95 percent CI, 5.30–8.90 percent) with adalimumab to 8.90 percent (5.70–13.52 percent) with rituximab. Compared with a 2.14-percent 1-year cumulative incidence of PJI with abatacept, predicted incidence with rituximab and tocilizumab ranged from 0.35 percent (0.11–1.12 percent) to 3.67 percent (1.69–7.88 percent), respectively.
Glucocorticoid use correlated with a dose-dependent increase in postoperative risk for all outcomes. Predicted risk for hospitalized infection from propensity-weighted models with use of glucocorticoid >10mg/d was 13.25 percent (9.72–17.81 percent; 6.78 percent for no glucocorticoid use), while predicted 1-year cumulative PJI incidence was 3.83 percent (2.13–6.87 percent; 2.09 percent for no glucocorticoid use).
This retrospective cohort study obtained Medicare and Truven MarketScan administrative data from January 2006 through September 2015. Participants included adults with rheumatoid arthritis who were having elective inpatient total knee or hip arthroplasty, either primary or revision, and received abatacept, adalimumab, etanercept, infliximab, rituximab or tocilizumab prior to surgery.
The authors performed propensity-adjusted analyses using inverse probability weights to assess comparative risks for hospitalized infection within 30 days and PJI within 1 year after surgery between biologics or with different dosages of glucocorticoids. Secondary analyses evaluated nonurinary tract hospitalized infections and 30-day readmissions.
Some limitations included a possible residual confounding and small sample sizes for rituximab and tocilizumab, according to the authors.