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Certain rheumatoid arthritis drugs raise infection risk. A large Danish study found that RA patients on TNF inhibitors or IL-6 receptor inhibitors had significantly higher rates of bloodstream infections compared to those not on these biologics. The risk was even steeper when patients were also taking oral steroids — a combination clinicians may want to reconsider.
A large Danish registry study has found that two common classes of rheumatoid arthritis (RA) biologics — TNF inhibitors and IL-6 receptor inhibitors — are associated with meaningfully higher rates of bloodstream infections compared to RA patients not on these therapies. The findings, published in Arthritis Research & Therapy, draw on data from over 24,000 patients spanning 2010 to 2024.
Not all drugs in these classes carried equal risk. Among TNF inhibitors, golimumab and infliximab stood out with the highest infection rates, while tocilizumab was the main driver among IL-6 inhibitors. Notably, abatacept and JAK inhibitors showed no significant increase in bloodstream infection risk.
Why it matters: For clinicians managing RA, these findings reinforce the need to weigh infection risk when selecting biologics — and to minimize concurrent glucocorticoid use wherever possible, as steroid co-administration was associated with substantially higher infection rates across both drug classes.
