RA: Risk for serious infections with leflunomide or tacrolimus vs TNFi after methotrexate failure

Key clinical point: The risks for any serious bacterial, opportunistic, or herpes zoster infections were similar with add-on leflunomide or tacrolimus and tumor necrosis factor inhibitors (TNFi) in patients with seropositive rheumatoid arthritis (RA) receiving methotrexate.

Major finding: The risk for any serious infection was not significantly different with leflunomide (propensity score fine stratification-weighted hazard ratio [pHR, 1.03; 95% CI 0.89-1.22) or tacrolimus (pHR 0.91; 95% CI 0.77-1.08) compared to TNFi.

Study details: This was a population-based cohort study including 72,516 patients with seropositive RA who were taking methotrexate, of which 20,262 patients initiated leflunomide, tacrolimus, or TNFi therapy.

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Disclosures: This study was supported by an investigator-sponsored grant from Hanlim pharmaceutical company. The authors declared no conflicts of interest.

Source: Shin A et al. Semin Arthritis Rheum. 2022 Apr 28. doi: 10.1016/j.semarthrit.2022.152019.