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Timing of Abatacept Before Elective Arthroplasty and Risk of Post-operative Outcomes

Author

George MD1, Baker JF1,2,3, Winthrop K4, Alemao E5, Chen L6, Connolly S5, Hsu JY1,3, Simon TA5, Wu Q3, Xie F6, Yang S6, Curtis JR6. Arthritis Care Res (Hoboken). 2019 Feb 11. doi: 10.1002/acr.23843. [Epub ahead of print]

Author Information

1 University of Pennsylvania, Division of Rheumatology.

2 Philadelphia Veterans Affairs Medical Center, Division of Rheumatology.

3 University of Pennsylvania, Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics.

4 Oregon Health & Science University, Divisions of Infectious Diseases, Public Health, and Preventive Medicine.

5 Bristol-Myers Squibb.

6 University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology.

Abstract

OBJECTIVES: 

Guidelines recommend holding biologic therapies before hip and knee arthroplasty, yet evidence to inform optimal timing is limited. We aimed to determine whether holding abatacept infusions is associated with lower risk of adverse post-operative outcomes.

METHODS: 

This retrospective cohort study using U.S. Medicare and Truven MarketScan administrative data from 2006-September 2015 evaluated adults with RA 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 non-urinary hospitalized infection and 30-day readmission.

RESULTS: 

After 1939 surgeries among 1780 patients, there were 175 (9.0%) hospitalized infections, 115 (5.9%) non-urinary hospitalized infections, 39 (2.4/100 person-years) PJI, and 114/1815 (6.3%) 30-day readmissions. There were no significant differences in outcomes with abatacept stop timing < 4 weeks (one dosing interval) vs. 4-8 weeks [hospitalized infection OR 0.93 (0.65-1.34), non-urinary hospitalized infection OR 0.93 (0.60-1.44), PJI HR 1.29 (0.62-2.69), 30-day readmission OR 1.00 (0.65-1.54)] or vs. ≥8 weeks. Glucocorticoid use > 7.5mg/day was associated with greater risk of hospitalized infection [OR 2.19 (1.28-3.77)] and non-urinary hospitalized infection [OR 2.38 (1.22-4.64)].

CONCLUSIONS: 

Compared to continuing intravenous abatacept, holding abatacept for ≥4 weeks (one dosing interval) before surgery was not associated with a lower risk of hospitalized infection, non-urinary hospitalized infection, PJI, or 30-day readmission.