Combination advanced therapy use and infection risks in immune-mediated inflammatory diseases
Main finding · First serious infection (requiring hospitalization or intravenous antibiotics)Result — go to the resultHazard ratio 1.61 95% CI 1.46–1.78Authors' conclusion
CAT was predominantly used within the spondyloarthritis umbrella of diseases. CAT exposure was associated with short duration and increased serious infection risk, although this risk varied by CAT regimen and underlying IMID.
Study context
- Population
- Individuals with immune-mediated inflammatory diseases (IMIDs) initiating advanced therapies between 2016 to 2023individuals who initiated 693,375 advanced therapy episodes
- Participants
- 270,198 individuals
- Exposure
- Combined versus single advanced therapy
- Combination advanced therapy (CAT)n = 38,456
- Outcome
- First serious infection (requiring hospitalization or intravenous antibiotics)
Methodological detailsMarketScan® databases, multivariate hazard ratios
- MarketScan® databases
- Multivariate hazard ratios
Main finding
As reported in the abstract
Hazard ratio
1.61
95% CI 1.46–1.78
By group
CAT
5.2
serious infections per 100 person-years
CATvs Monotherapy
HR 1.61 (95% CI 1.46–1.78)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Serious infection, anti-adhesion agents combined with TNFivs other combinations | 1.49 (1.09–2.04) | |
| 0.512Hazard ratio (log scale) |
Serious infection, IMID-stratified analysis
- CAT (versus monotherapy) associated with higher risk of serious infection across all diseases, except AxSpA
CAT episodes
- Individuals who started CAT episodes
- 38,456 (14.2%)
- CAT episodes started
- 52,212
- CAT episodes involving TNFi exposure
- 51.2%
- Median duration of first CAT exposure
- 42 days
- Most common IMIDs among CAT users: psoriasis, inflammatory bowel disease, rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis (AxSpA)
Original publication
Combination advanced therapy use and infection risks in immune-mediated inflammatory diseases. Rheumatology (Oxford). Published 3 November 2026. doi:10.
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