Summary of serious infection risk and other infectious considerations by pharmacological class
| Drug | Serious infection risk | Other infection considerations |
| Conventional synthetic DMARDs | Minimal increase in serious infection risk8 10 | |
| Abatacept | Possibly slightly lower risk versus TNFi14 | Herpes zoster35 |
| Rituximab | Similar or possibly lower risk versus TNFi21 22 | Hepatitis B reactivation; Pneumocystis jirovecii pneumonia, PML3 49 51 |
| TNF inhibitors | 1–2 additional serious infections/100 person-years1 13 | Herpes zoster; tuberculosis reactivation3 35 |
| Low-dose glucocorticoids (<10 mg/day) | 1–2 additional serious infections/100 person-years27 31 | Increased risk for herpes zoster in combination with JAK inhibitors36 |
| JAK inhibitors | Similar risk versus TNFi25 26 | Greater risk of herpes zoster, especially in combination with glucocorticoids25 36 |
| IL-6 inhibitors | Similar to slightly higher risk versus TNFi19 20 | Herpes zoster35 |
| High-dose glucocorticoids (>10 mg/day) | Greatest risk for infection (approximately doubles infection risk)27 31 | Hepatitis B reactivation; Pneumocystis jirovecii pneumonia (doses >20 mg/day or in combination with other therapies); herpes zoster, especially in combination with JAK inhibitors36 45 |
Summary of risk of serious infections and other infectious considerations with immunomodulatory therapy.
DMARD, disease-modifying antirheumatic drug; IL, interleukin; JAK, Janus kinase; PML, progressive multifocal leukoencephalopathy; TNF, tumour necrosis factor; TNFi, tumour necrosis factor inhibitors.