LAUSR

OBJECTIVES To determine the impact of the introduction of biologic disease-modifying anti-rheumatic drugs (bDMARDs) on severe infections among people newly diagnosed with rheumatoid arthritis (RA) compared with non-RA individuals. METHODS In this population-based retrospective cohort study using administrative data (from 1990-2015) for British Columbia, Canada, all incident RA patients diagnosed between 1995 and 2007 were identified. General population controls with no inflammatory arthritis were matched to RA patients based on age and gender, and were assigned the diagnosis date (i.e., index date) of the RA patients they were matched with. RA/controls were then divided into quarterly cohorts according to their index dates. The outcome of interest was all severe infections (SI) necessitating hospitalization or occurring during hospitalization after index date. We calculated 8-year SI rates for each cohort and conducted interrupted time-series analyses to compare SI trends in RA/controls with index date during pre-bDMARDs (1995-2001) and post-bDMARDs (2003-2007) periods. RESULTS A total of 60,226 and 588,499 incident RA/controls were identified. We identified 14,245 SI in RA, and 79,819 SI in controls. The 8-year SI rates decreased among RA/controls with increasing calendar year of index date in the pre-bDMARDs period, but increased over time only among RA, not controls, with index date in the post-period. The adjusted difference between the pre- and post-bDMARDs secular trends in 8-year SI rates was 1.85 (P = 0.001) in RA and 0.12 (P = 0.29) in non-RA. CONCLUSION RA onset after bDMARDs introduction was associated with an elevated severe infection risk in RA patients, compared with matched non-RA individuals.