{"doi":"10.1002/acr.25282","title":"Frailty and Risk of Serious Infections in Patients With Rheumatoid Arthritis Treated With Biologic or <scp>Targeted‐Synthetic Disease‐Modifying</scp> Antirheumatic Drugs","abstract":"OBJECTIVE: It remains unknown whether frailty status portends an increased risk of adverse outcomes in patients with rheumatoid arthritis (RA) initiating biologic or targeted-synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs). The objective of our study was to evaluate the association between frailty and serious infections in a younger population of patients (<65 years old) with RA who initiated b/tsDMARDs. METHODS: Using MarketScan data, we identified new users of tumor necrosis factor inhibitors (TNFi), non-TNFi biologic DMARDs, or Janus kinase inhibitors (JAKi) between 2008 and 2019 among those with RA. Patients' baseline frailty risk score was calculated using a Claims-Based Frailty Index (≥0.2 defined as frail) 12 months prior to drug initiation. The primary outcome was time to serious infection; secondarily, we examined time-to-any infection and all-cause hospitalizations. We used Cox proportional hazards to estimate adjusted hazard ratios and 95% confidence intervals (95% CIs) and assessed the significance of interaction terms between frailty status and drug class. RESULTS: A total of 57,980 patients, mean (±SD) age 48.1 ± 10.1 were included; 48,139 (83%) started TNFi, 8,111 (14%) non-TNFi biologics, and 1,730 (3%) JAKi. Among these, 3,560 (6%) were categorized as frail. Frailty was associated with a 50% increased risk of serious infections (adjusted hazard ratio [95% CI] 1.5, 1.2-1.9) and 40% higher risk of inpatient admissions (1.4 [1.3-1.6]) compared with nonfrail patients among those who initiated TNFi. Frailty was also associated with a higher risk of any infection relative to nonfrail patients among those on TNFi (1.2 [1.1-1.3]) or non-TNFi (1.2 [1.0-1.4]) or JAKi (1.4 [1.0-2.0]). CONCLUSION: Frailty is an important predictor for the risk of adverse outcomes among patients with RA treated with biologic or targeted-synthetic DMARDs.","journal":"Arthritis Care & Research","year":2023,"id":329347,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":20,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9666,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":521820,"name":"Laura S. Gold","orcid":"0000-0002-4289-5231","position":1,"is_corresponding":false},{"id":503342,"name":"Jiha Lee","orcid":"0000-0002-6402-6563","position":2,"is_corresponding":false},{"id":497055,"name":"Katherine D. Wysham","orcid":"0000-0001-8707-7649","position":3,"is_corresponding":false},{"id":497057,"name":"James S. Andrews","orcid":"0000-0003-2302-4358","position":4,"is_corresponding":false},{"id":1052029,"name":"Una E. Makris","orcid":"0000-0003-4750-0777","position":5,"is_corresponding":false},{"id":314415,"name":"Bryant R. England","orcid":"0000-0002-9649-3588","position":6,"is_corresponding":false},{"id":305805,"name":"Michael George","orcid":"0000-0002-0398-2308","position":7,"is_corresponding":false},{"id":305808,"name":"Joshua F. Baker","orcid":"0000-0003-0799-7563","position":8,"is_corresponding":false},{"id":339456,"name":"Jeffrey G. Jarvik","orcid":"0000-0002-0528-3455","position":9,"is_corresponding":false},{"id":373971,"name":"Patrick J. Heagerty","orcid":"0000-0002-3403-6007","position":10,"is_corresponding":false},{"id":218569,"name":"Siddharth Singh","orcid":"0000-0002-2640-7269","position":11,"is_corresponding":false},{"id":626070,"name":"Namrata Singh","orcid":"0000-0001-7149-363X","position":0,"is_corresponding":true}],"reference_count":23,"raw_metadata":null,"created_at":"2026-07-19T01:09:01.509601Z","pmid":"38116680","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}