A French registry analysis compared the risk of diverticulitis and gastrointestinal perforation (GIP) in rheumatoid arthritis (RA) patients treated with biologics and found a greater risk of both in patients receiving tocilizumab (TCZ) compared with those on rituximab (RTX) or abatacept (ABA). It appears the increased risk with TCZ related to the increased risk of diverticulitis with TCZ.
After propensity score matching of treatment groups, the risk of diverticulitis or GIP was calculated.
They found a 3 fold higher risk of diverticulitis in TCZ treated patients compared with RTX or ABA treated patients (HR=3.1 [95% confidence interval 1.5–6.3], p= 0.002). They also found TCZ to have an increased risk of GIP due to diverticulitis compared with those treated with RTX or ABA (HR = 3.8 [1.1–13.6], p= 0.04), resulting in an overall increased risk of GIP (HR = 2.9 [1.1–7.8], p= 0.03).
TCZ was associated with an earlier risk of diverticulitis and GIP (p= 0.01), atypical clinical presentation (slow transit in 30%, p= 0.04) and lower acute-phase reactants at the time of the event (p= 0.005).
TCZ has an increased odds of diverticulitis, as well as GIP due to diverticulitis, as compared with RTX and ABA. .