University of Pennsylvania Perelman School of Medicine, Philadelphia.
Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennyslvania.
Arthritis Care Res (Hoboken). 2019 Sep;71(9):1224-1233. doi: 10.1002/acr.23843. Epub 2019 Jul 11.
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.
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.
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]).
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.
指南建议在髋关节和膝关节置换术前暂停使用生物制剂，但目前用于指导最佳时机选择的证据有限。本研究旨在确定是否暂停阿巴西普输注与降低术后不良结局风险相关。
本回顾性队列研究使用了美国医疗保险和 Truven MarketScan 行政管理数据，时间范围为 2006 年 1 月至 2015 年 9 月，评估了在择期初次或翻修髋关节或膝关节置换术前 6 个月内接受过静脉内阿巴西普（在索赔数据中精确记录日期）治疗的类风湿关节炎患者。使用逆概率权重进行倾向评分分析，比较不同阿巴西普停药时间（末次输注与手术之间的时间）患者的 30 天住院感染和 1 年假体关节感染（PJI）风险。次要分析评估了非泌尿道住院感染和 30 天再入院。
在 1780 例患者的 1939 例手术中，有 175 例发生了住院感染（9.0%），115 例非泌尿道住院感染（5.9%），39 例 PJI（2.4/100 人年）和 114 例/1815 例 30 天再入院（6.3%）。阿巴西普停药时间<4 周（1 个用药间隔）与 4-8 周（住院感染比值比[OR]0.93[95%置信区间（95%CI）0.65-1.34]）或≥8 周（住院感染 OR 0.92[95%CI 0.64-1.32]）无显著差异；非泌尿道住院感染 OR 0.93[95%CI 0.60-1.44]）；PJI 风险比 1.29[95%CI 0.62-2.69]）；30 天再入院 OR 1.00[95%CI 0.65-1.54]）。同样，阿巴西普停药时间<4 周与≥8 周之间的结局也无显著差异。>7.5mg/天的糖皮质激素使用与住院感染（OR 2.19[95%CI 1.28-3.77]）和非泌尿道住院感染（OR 2.38[95%CI 1.22-4.64]）风险增加相关。
与继续静脉内阿巴西普相比，手术前至少停药 4 周（1 个用药间隔）并未降低住院感染、非泌尿道住院感染、PJI 或 30 天再入院风险。
