Risk of Serious Infections in Patients with Rheumatoid Arthritis Receiving Biological and Targeted Synthetic DMARDs: A Single-Center, Retrospective Cohort Study

Authors : Emrah Koç, Elif İde Emir Okan, Mete Pekdiker, Gezmiş Kimyon

Pages : 18-22

View : 60 | Download : 150

Publication Date : 2026-01-19

Article Type : Research Paper

Abstract :Objective: To evaluate the effect of biological (bDMARD) and targeted synthetic (tsDMARD) disease-modifying antirheumatic drugs on the risk of serious infections (SI) and to identify associated risk factors in patients with rheumatoid arthritis (RA). Materials and Methods: This retrospective cohort study included RA patients followed at a single tertiary care center between August 2018 and August 2024. Patients meeting the ACR/EULAR 2010 criteria were divided into three groups: those receiving b/tsDMARDs (n=199), those receiving only conventional synthetic DMARDs (csDMARDs) (n=50), and healthy controls (n=50). SI was defined as infections requiring hospitalization. Demographic, clinical, and treatment data were collected from electronic medical records. Multiple logistic regression analysis was used to analyze risk factors. ROC curve analysis was performed to evaluate the effect of treatment duration. Statistical analyses were performed using SPSS version 27 (IBM). Results: SI occurred in 15.8% (n=31) of patients in the b/tsDMARD group, compared to 14% (n=7) in the csDMARD group and 4% (n=2) in the control group. b/tsDMARD use significantly increased the risk of SI compared to healthy controls (OR: 3.66; 95% CI: 1.09-12.28; p=0.035), but no significant difference was found compared to the csDMARD group (p=0.781). In multiple regression analysis, advanced age (p=0.005) and prolonged b/tsDMARD use (p=0.014) were identified as independent risk factors for SI. ROC analysis identified 57.5 months of treatment duration as a threshold value for SI risk (Area Under the Curve: 0.624; p=0.023). Treatment duration exceeding this threshold increased the risk by 1.175-fold (p=0.009). Among drugs, rituximab use was associated with a higher risk of SI compared to other agents (OR: 1.72; p=0.005). Pneumonia was the most common site of SI. Conclusion: b/tsDMARD therapy increases the risk of SI in RA patients, particularly with prolonged use and in advanced age. The risk may vary among different biological agents; in our study, rituximab was associated with a higher risk. These findings emphasize the importance of personalized risk-benefit assessment and close monitoring for infections in RA management.
Keywords : Romatoid Artrit, Biyolojik DMARD, Enfeksiyon

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