Table 1

Summary of serious infection risk and other infectious considerations by pharmacological class

DrugSerious infection riskOther infection considerations
Conventional synthetic DMARDsMinimal increase in serious infection risk8 10
AbataceptPossibly slightly lower risk versus TNFi14Herpes zoster35
RituximabSimilar or possibly lower risk versus TNFi21 22Hepatitis B reactivation; Pneumocystis jirovecii pneumonia, PML3 49 51
TNF inhibitors1–2 additional serious infections/100 person-years1 13Herpes zoster; tuberculosis reactivation3 35
Low-dose glucocorticoids (<10 mg/day)1–2 additional serious infections/100 person-years27 31Increased risk for herpes zoster in combination with JAK inhibitors36
JAK inhibitorsSimilar risk versus TNFi25 26Greater risk of herpes zoster, especially in combination with glucocorticoids25 36
IL-6 inhibitorsSimilar to slightly higher risk versus TNFi19 20Herpes zoster35
High-dose glucocorticoids
(>10 mg/day)
Greatest risk for infection (approximately doubles infection risk)27 31Hepatitis 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.