TNF drugs - surgery and infection risks - Increased

[Mike Bartolatz]

TNF Inhibitor Therapy May Increase Risk of Serious Post-operative Infection
Source: American College of Rheumatology (ACR)
http://www.newswise.com/articles/view/507627/?sc=wire

TNF inhibitor therapy, which has proven successful in reducing
inflammation in patients with rheumatoid arthritis, may increase the
risk of serious post-operative infections when taken prior to orthopedic
surgery, according to research presented this week at the American
College of Rheumatology Annual Scientific Meeting in San Antonio, Texas.

Genetically-engineered, or biologic, tumor necrosis factor (TNF)
inhibitors suppress the TNF proteins that cause joint inflammation, a
beneficial therapy in the day-to-day lives of many arthritis patients.
However, because the same TNF protein also plays a key role in
suppressing infections with certain bacteria in the body, continued use
of TNF inhibitors prior to surgery could increase the risk of many types
of infections, such as septic arthritis, osteomyelitis or deep wound
infection, following surgery.

To assess this post-operative risk, researchers evaluated the outcome of
91 rheumatoid arthritis patients, average age 59.5 years, who underwent
bone or joint surgery between January 1, 1999 and March 15, 2004.
Patients who developed deep bone or soft tissue infections within 30
days after surgery were identified and their medications were reviewed.

Of 35 patients receiving treatment with a TNF inhibitor at the time of
surgery, seven developed a post-operative infection. In contrast, only
three of 56 patients not receiving a TNF inhibitor at the time of
surgery developed an infection. TNF inhibitor use was associated with a
four-fold increase in risk for infection.

TNF inhibitors such as etanercept, infliximab and adalimumab can be
discontinued and restarted without impairing the health of patients.
However, since each drug has a distinct half-life, patients should ask
their physician for pre-surgery guidelines.

"These data are preliminary," said Joan M. Bathon, MD, John Hopkins
Arthritis Center, Johns Hopkins University, Baltimore, Maryland, and an
investigator in the study. "However, because postoperative infections
can be devastating and life threatening, a cautious approach in
discontinuing TNF inhibitors prior to bone and joint surgery seems
prudent."