SynthesisEuropean journal of clinical pharmacology2026
Infection risks associated with b/tsDMARDs in rheumatoid arthritis: a systematic review and network meta-analysis.
Synthesis in European journal of clinical pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
12 authors.
Funding
Abstract
objectivesTo evaluate infection risks in rheumatoid arthritis (RA) patients with biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) as monotherapy or combined with conventional synthetic DMARDs (csDMARDs).
methodsA comprehensive literature search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov from their inception to 31 October 2024 was conducted to identify randomized controlled trials (RCTs) assessing infection risks in RA patients receiving b/tsDMARDs. Primary outcome was serious infection incidence; secondary outcomes included any infection and specific events such as respiratory tract infections, gastroenteritis and herpes zoster. A frequentist network meta-analysis was performed to calculate odds ratios (ORs).
resultsA total of 127 RCTs involving 55,749 patients were included. b/tsDMARD monotherapy showed a similar risk of serious infections versus csDMARDs. Combining csDMARDs with adalimumab, infliximab, tofacitinib, or upadacitinib (though not with other b/tsDMARDs) was associated with a significantly increased risk of serious infections (OR 1.51, 95% CI: 1.04-2.19; OR 1.75, 95% CI: 1.09-2.81; OR 2.52, 95% CI: 1.26-5.03; OR 2.31, 95% CI: 1.13-4.73). For any infection, b/tsDMARD monotherapy posed a similar risk to csDMARDs, except for etanercept. Certain tsDMARDs were associated with an increased incidence of herpes zoster versus csDMARDs, except for filgotinib and peficitinib.
conclusionCompared to csDMARDs, b/tsDMARD monotherapy showed no elevated serious infection risk, whereas specific combinations increased the risk of serious infections in RA patients. A clinical reference pathway was developed to inform drug selection optimization for RA patients receiving b/tsDMARDs.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.