TY - JOUR
T1 - Timing of Abatacept Before Elective Arthroplasty and Risk of Postoperative Outcomes
AU - George, Michael D.
AU - Baker, Joshua F.
AU - Winthrop, Kevin
AU - Alemao, Evo
AU - Chen, Lang
AU - Connolly, Sean
AU - Hsu, Jesse Y.
AU - Simon, Teresa A.
AU - Wu, Qufei
AU - Xie, Fenglong
AU - Yang, Shuo
AU - Curtis, Jeffrey R.
N1 - Funding Information:
Supported by Bristol-Myers Squibb. Dr. George’s work was supported by the Rheumatology Research Foundation Scientist Development Award and the N 阀H (National 阀nstitute of Arthritis and Musculoskeletal and Skin Diseases grant 1K23-AR-073931-01). Dr. Curtis’ work was supported by the Patient Centered Outcomes Research 阀nstitute (grant PPRND-1507-32163). 1Michael D. George, MD, MSCE, Jesse Y. Hsu, PhD, Qufei Wu, MS: University of Pennsylvania Perelman School of Medicine, Philadelphia; 2Joshua F. Baker, MD, MSCE: Philadelphia Veterans A 贀airs Medical Center, Philadelphia, Pennyslvania; 3Kevin Winthrop, MD, MPH: Oregon Health & Science University, Portland; 4Evo Alemao, RPh, PhD, Teresa A. Simon, MPH: Bristol-Myers Squibb, Princeton, New Jersey; 5Lang Chen, PhD, Fenglong Xie, MS, Shuo Yang, MS, Je 贀rey R. Curtis, MD, MS, MPH: University of Alabama at Birmingham; 6Sean Connolly, PhD: Bristol-Myers Squibb, Plainsboro, New Jersey. Dr. George has received consulting fees from AbbVie (less than $10,000) and research support from Bristol-Myers Squibb. Dr. Baker
Publisher Copyright:
© 2019, American College of Rheumatology
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Objective: Guidelines recommend withholding biologic therapies before hip and knee arthroplasty, yet evidence to inform optimal timing is limited. The aim of this study was to determine whether withholding abatacept infusions is associated with lower risk of adverse postoperative outcomes. Methods: This retrospective cohort study, which used US Medicare and Truven MarketScan administrative data from January 2006 to September 2015, evaluated adults with rheumatoid arthritis who received intravenous abatacept (precisely dated in claims data) within 6 months of elective primary or revision hip or knee arthroplasty. Propensity weighted analyses using inverse probability weights compared the risk of 30-day hospitalized infection and 1-year prosthetic joint infection (PJI) between patients with different abatacept stop timing (time between last infusion and surgery). Secondary analyses evaluated nonurinary hospitalized infections and 30-day readmissions. Results: After 1,939 surgeries among 1,780 patients, there were 175 hospitalized infections (9.0%), 115 nonurinary hospitalized infections (5.9%), 39 PJIs (2.4/100 person-years), and 114/1,815 30-day readmissions (6.3%). There were no significant differences in outcomes with abatacept stop timing <4 weeks (1 dosing interval) versus 4–8 weeks (hospitalized infection odds ratio [OR] 0.93 [95% confidence interval (95% CI) 0.65–1.34]; nonurinary hospitalized infection OR 0.93 [95% CI 0.60–1.44]; PJI hazard ratio 1.29 [95% CI 0.62–2.69]; 30-day readmission OR 1.00 [95% CI 0.65–1.54]). Similarly, there were no significant differences in outcomes with abatacept stop timing <4 weeks versus ≥8 weeks. Glucocorticoid use >7.5 mg/day was associated with greater risk of hospitalized infection (OR 2.19 [95% CI 1.28–3.77]) and nonurinary hospitalized infection (OR 2.38 [95% CI 1.22–4.64]). Conclusion: Compared to continuing intravenous abatacept, withholding abatacept for ≥4 weeks (one dosing interval) before surgery was not associated with a lower risk of hospitalized infection, nonurinary hospitalized infection, PJI, or 30-day readmission.
AB - Objective: Guidelines recommend withholding biologic therapies before hip and knee arthroplasty, yet evidence to inform optimal timing is limited. The aim of this study was to determine whether withholding abatacept infusions is associated with lower risk of adverse postoperative outcomes. Methods: This retrospective cohort study, which used US Medicare and Truven MarketScan administrative data from January 2006 to September 2015, evaluated adults with rheumatoid arthritis who received intravenous abatacept (precisely dated in claims data) within 6 months of elective primary or revision hip or knee arthroplasty. Propensity weighted analyses using inverse probability weights compared the risk of 30-day hospitalized infection and 1-year prosthetic joint infection (PJI) between patients with different abatacept stop timing (time between last infusion and surgery). Secondary analyses evaluated nonurinary hospitalized infections and 30-day readmissions. Results: After 1,939 surgeries among 1,780 patients, there were 175 hospitalized infections (9.0%), 115 nonurinary hospitalized infections (5.9%), 39 PJIs (2.4/100 person-years), and 114/1,815 30-day readmissions (6.3%). There were no significant differences in outcomes with abatacept stop timing <4 weeks (1 dosing interval) versus 4–8 weeks (hospitalized infection odds ratio [OR] 0.93 [95% confidence interval (95% CI) 0.65–1.34]; nonurinary hospitalized infection OR 0.93 [95% CI 0.60–1.44]; PJI hazard ratio 1.29 [95% CI 0.62–2.69]; 30-day readmission OR 1.00 [95% CI 0.65–1.54]). Similarly, there were no significant differences in outcomes with abatacept stop timing <4 weeks versus ≥8 weeks. Glucocorticoid use >7.5 mg/day was associated with greater risk of hospitalized infection (OR 2.19 [95% CI 1.28–3.77]) and nonurinary hospitalized infection (OR 2.38 [95% CI 1.22–4.64]). Conclusion: Compared to continuing intravenous abatacept, withholding abatacept for ≥4 weeks (one dosing interval) before surgery was not associated with a lower risk of hospitalized infection, nonurinary hospitalized infection, PJI, or 30-day readmission.
UR - http://www.scopus.com/inward/record.url?scp=85062588137&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85062588137&partnerID=8YFLogxK
U2 - 10.1002/acr.23843
DO - 10.1002/acr.23843
M3 - Article
C2 - 30740938
AN - SCOPUS:85062588137
SN - 2151-464X
VL - 71
SP - 1224
EP - 1233
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 9
ER -