Should immunosupressants be paused during infection?

Continuation of immunomodulatory agents during infection appears as safe as temporary interruption in inflammatory rheumatic disease (IRD) patients, with no significant difference in serious infection rates.

Study details: A large, multicenter, open-label randomized trial enrolled 1,142 patients with IRDs on immunomodulatory agents (IA). Upon their first clinically relevant infection, patients were randomized 1:1 to either continue or temporarily interrupt IA therapy. Primary outcome was the proportion of patients experiencing a serious infection (requiring hospitalization or IV therapy), analyzed in a modified intention-to-treat population of 474 patients who developed infection during follow-up.

Results: Serious infections occurred in 5.15% of the interruption group and 3.73% of the continuation group, with an adjusted risk difference of 1.71% (95% confidence interval [CI], -1.99 to 5.39). Complier Average Causal Effect analysis favored continuation, but CIs were wide and included zero. The study was limited by low statistical power.

Source:

Opdam MAA, et al. (2025, August 12). Clin Infect Dis. Continuation versus temporary interruption of immunomodulatory agents during infections in patients with inflammatory rheumatic diseases: a randomized controlled trial. https://pubmed.ncbi.nlm.nih.gov/40796336/