Nonserious infections (NSIE) as colds, flu syndromes, and urinary tract infection, are the most common infections seen in patients with immune mediated inflammatory diseases. Yet, little is known about the impact of immunosuppression, particularly with tumor necrosis factor inhibitors (TNFi), on these infections. A systemic review of large, randomized controlled trials was conducted to identify incidence, types, and outcomes of NSIE associated with the most commonly prescribed TNFi: adalimumab, etanercept, and infliximab.
Key Points
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RA patients commonly encounter nonserious infections (NSIE) as upper respiratory tract infection, minor skin/soft tissue infections, urinary tract infections.
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Anti-TNF therapy can increase the risk for NSIE.
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NSIE are likely self-limited and may not progress to more serious infections.
Introduction
Although the use of biologic agents is becoming more commonplace in clinical practice, concern for safety has been mounting. The tumor necrosis factor-alpha inhibitors (TNFi) are the most commonly prescribed biologic agents for the treatment of immune-mediated inflammatory diseases (IMID). Five TNFi are commercially available in the United States for clinical use: adalimumab (ADA), etanercept (ETN), infliximab (INF), golimumab, and certolizumab. Many studies have published on adverse events (AE) associated with these biologics, with the vast majority focusing on serious infectious events (SIE), which have been defined as infections that are life-threatening or those that require hospitalization or intravenous (IV) antibiotics. However, very limited data are available on the most prevalent AE encountered by patients who are routinely treated with TNFi: the nonserious infections (NSIE). NSIE may include upper respiratory tract infections (URI), influenza (flu) syndromes, urinary tract infections (UTI), and skin/soft tissue infections (SSI). These infections account for more than 50 million outpatient or emergency department visits annually, with an estimated economic burden of more than $40 billion in direct and indirect costs. Fig. 1 shows the estimated annual socioeconomic burden of NSIE in the general US population.
