Rheumatology International

, Volume 39, Issue 3, pp 497–507 | Cite as

Incidence of infection other than tuberculosis in patients with autoimmune rheumatic diseases treated with bDMARDs: a real-time clinical experience from India

  • S. ChandrashekaraEmail author
  • Vineeta Shobha
  • Vijay Rao
  • Anu Desai
  • Ramesh Jois
  • B. G. Dharmanand
  • Sharath Kumar
  • Pradeep Kumar
  • Chethana Dharmapalaiah
  • Kurugodu Mathada Mahendranath
  • Shiva Prasad
  • Manisha Ashwin Daware
  • Yogesh Singh
  • Uma Karjigi
  • S. Nagaraj
  • K. R. Anupama
Observational Research


Biologic disease-modifying anti-rheumatic drugs (bDMARD) have transformed the treatment paradigm of chronic autoimmune rheumatic diseases (ARDs), but they are often associated with adverse drug reactions. The present study evaluated the frequency, characteristics and type of infections, other than tuberculosis (TB), in ARD patients receiving bDMARDs. The multicentre, cross-sectional, retrospective, observational study was conducted across 12 centers in Karnataka, India, between January to August 2016. The study included patients receiving bDMARD therapy for various ARDs. Outcome variables considered were any infection, minor infections and major infections, other than TB. Clinical variables were compared between infection and no infection group, and the increase in the likelihood of infection with respect to various clinical variables was assessed. The study involved 209 subjects with a median (range) age of 41 (16–84) years and male to female ratio of 0.97:1. A total of 29 (13.88%) subjects developed infection following bDMARD therapy, out of whom a majority had minor infection (n = 26). The likelihood of developing any infection was noted to be more in subjects receiving anti-TNF (golimumab, P = 0.03) and those on three or more conventional synthetic (cs) DMARDs (P < 0.01). Infection risk was higher in patients with systemic lupus erythematosus (P = 0.04), other connective tissue disease (P < 0.01) and in patients with comorbidities (P = 0.13). The risk of infection was associated with the use of anti-TNF therapy and more than three csDMARDs, co morbidities and Adds such as systemic lupus erythematosus and connective tissue disease.


bDMARDs Infection ARDs csDMARDS Comorbidities 



The authors acknowledge the help of Research Assist ( for editing and formatting the manuscript.


Karnataka Rheumatology Association (Association of rheumatologists).

Compliance with ethical standards

Conflict of interest

Authors S. Chandrashekara, Vineeta Shobha, Vijay Rao, Anu Desai, Ramesh Jois, B. G. Dharmanand, Sharath Kumar, Pradeep Kumar, Chethana Dharmapalaiah, Kurugodu Mathada Mahendranath, Shiva Prasad, Manisha Ashwin Daware, Yogesh Singh, Uma Karjigi, Nagaraj S, and K. R. Anupama declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

296_2019_4245_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 30 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • S. Chandrashekara
    • 1
    Email author
  • Vineeta Shobha
    • 2
  • Vijay Rao
    • 3
  • Anu Desai
    • 2
  • Ramesh Jois
    • 4
  • B. G. Dharmanand
    • 5
  • Sharath Kumar
    • 6
  • Pradeep Kumar
    • 7
  • Chethana Dharmapalaiah
    • 8
  • Kurugodu Mathada Mahendranath
    • 9
  • Shiva Prasad
    • 10
  • Manisha Ashwin Daware
    • 11
  • Yogesh Singh
    • 3
  • Uma Karjigi
    • 7
  • S. Nagaraj
    • 12
  • K. R. Anupama
    • 1
  1. 1.ChanRe Rheumatology and Immunology Center and ResearchBangalore-10India
  2. 2.St. John’s Medical College HospitalBangaloreIndia
  3. 3.Manipal HospitalBangaloreIndia
  4. 4.Fortis HospitalBangaloreIndia
  5. 5.SAKRA HospitalBangaloreIndia
  6. 6.Columbia Asia HospitalBangaloreIndia
  7. 7.Apollo HospitalBangaloreIndia
  8. 8.Aster CMI HospitalBangaloreIndia
  9. 9.Samarpan Health CentreBangaloreIndia
  10. 10.Vikram Hospital and Heart CareMysoreIndia
  11. 11.Narayana Health CityBangaloreIndia
  12. 12.SPARSH HospitalBangaloreIndia

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