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Evidence Weighed for Perioperative Use of bDMARDs

Limited evidence suggests that continuing biological DMARDs may lower risk for disease flares without increasing risk for postop complications

By Physician’s Briefing Staff | February 28, 2022

For patients undergoing surgical procedures, continuing biologic disease-modifying antirheumatic drugs (bDMARDs) is associated with a decrease in the risk for disease flares and statistically nonsignificant increases in the risks for surgical site infections and wound complications, according to a review published online Feb. 17 in the Journal of Bone & Joint Surgery .

Bernard H. van Duren, M.B.Ch.B., D.Phil., from the University of Leeds in the United Kingdom, and colleagues conducted a systematic review to compare the risk for infection, delayed wound healing, and disease flares associated with the use of bDMARDs in patients undergoing orthopedic surgical procedures. Eleven studies were included, with data for 7,344 patients: 2,385 who continued and 4,959 who withheld their bDMARDs perioperatively.

The researchers found that compared with withholding bDMARDs, continuing bDMARDs was associated with a lower risk for disease flares (odds ratio, 0.22; 95 percent confidence interval, 0.05 to 0.95; P = 0.04). The risks for surgical site infections (odds ratio, 1.11; 95 percent confidence interval, 0.82 to 1.49; P = 0.49) and wound complications (odds ratio, 2.16; 95 percent confidence interval, 0.48 to 9.85; P = 0.32) were increased in association with continuing bDMARDs, but the differences were not statistically significant.

"A significant increase in disease flares was noted among patients who withheld their bDMARDs," the authors write. "Despite capturing data on a large number of patients, we remain cautious regarding the reliability of these data because of the variable quality of the available studies and the lack of randomized controlled trials."

Two authors disclosed financial ties to the pharmaceutical and medical device industries.

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