Silva–Fernández L, et al. – The experts undertook this study to compare the risk of serious infections (SIs) in the first year after a switch to either TNF inhibitors (TNFi) or rituximab (RTX) in patients after initial TNFi failure. Results showed that in these patients, the risk of SIs was comparable over the first year of treatment between TNFi and RTX treatment.

Methods

• This study consisted of patients with RA registered with the British Society for Rheumatology Biologics Register (BSRBR–RA) who switched to either a second TNFi or RTX after failing a first TNFi. 
• Patients were followed until first SI, treatment discontinuation, last recorded follow–up or the end of the first year after the switch, whichever came first.
• SI was defined as requiring hospitalization, intravenous antibiotics or resulting in death.
• The risk of first SI was compared between TNFi and RTX using Cox proportional hazard models adjusted using propensity scores using inverse probability of treatment weighting.

Results

• This study selected 3419 TNFi and 1396 RTX patients contributing 2765 and 1224 person–years (pyrs), respectively.
• As per the outcomes, SI occurred in 164 (4.8%) TNFi and 81 (5.8%) RTX patients giving a crude rate of 59 and 66 SI/1000 pyrs, respectively. 
• 1.0 was the adjusted hazard ratio for SI (95% CI: 0.7, 1.4).