TITLE:
Perioperative Use of Methotrexate and Tumor Necrosis Factor α Inhibitors Combination Therapy Is Not Likely to Increase Post-Operative Infection Rate in the National Veterans Health Administration Administrative Databases
AUTHORS:
Hsin-Hsuan Juo, Anders Peck, Sarah E. Monsell, Bernard Ng
KEYWORDS:
Rheumatoid Arthritis, Perioperative Management, Outcome, Methotrexate and Tumor Necrosis Factor Combination Therapy
JOURNAL NAME:
Open Journal of Rheumatology and Autoimmune Diseases,
Vol.9 No.1,
February
3,
2019
ABSTRACT: Objective: The aim of the study is to assess the risk of post-operative outcome
in rheumatoid arthritis (RA) patients continuing versus stopping combination
therapy of methotrexate (MTX) and hydroxychloroquine (HCQ) or
tumor necrosis factor α inhibitors (TNF) prior to surgery. Methods: Using
the United States Veterans Affairs (VA) databases, we identified surgical
procedures in a 17-year cohort of RA patients. Among those patients, those
on MTX + HCQ or MTX + TNF were identified. Post-operative outcome variables
include infection, length of post-operative hospital stay and death. Results: We identified a total of 29,708 surgeries in RA patients. Among
them, we identified the most recent elective surgeries without pre-operative
infection in 16,174 patients. There were 783 and 550 patients on MTX + HCQ
and MTX + TNF, respectively. The rates of post-op infection were 5% and 4%
for the MTX + HCQ and MTX + TNF continuing medication groups, respectively,
similar to the general RA population (5%). Sensitivity analyses at various
time points of discontinuation combination therapies prior to surgery did
not show significant change in terms of infection. Conclusions: The prevalence
of adverse outcome is low. The proportion of post-operative infection
in continuing and discontinuing medicine groups is similar for both MTX +
HCQ and MTX + TNF. While we were unable to formally compare proportions of post-operative infection among the two groups, these preliminary
findings do not support the hypothesis that continuing either MTX + TNF or
MTX + HCQ combination during perioperative period increases post-operative
infection compared with discontinuation prior to therapy.