Cardiovascular Risk in Rheumatoid Arthritis: Comparing TNF-¦Á Blockade with Nonbiologic DMARDs

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• 作者：Daniel H. Solomon ; Jeffrey R. Curtis ; Kenneth G. Saag ; Joyce Lii ; Lang Chen ; Leslie R. Harrold ; Lisa J. Herrinton ; David J. Graham ; Mary K. Kowal ; Bindee Kuriya ; Liyan Liu ; Marie R. Griffin ; James D. Lewis ; Jeremy A. Rassen
• 关键词：Cardiovascular disease ; Rheumatoid arthritis ; TNF-¦Á blocking agents
• 刊名：The American Journal of Medicine
• 出版年：2013
• 出版时间：August, 2013
• 年：2013
• 卷：126
• 期：8
• 页码：730.e9-730.e17
• 全文大小：395 K

文摘

Background

Elevated tumor necrosis factor (TNF)-¦Á likely contributes to the excess cardiovascular risk observed in rheumatoid arthritis. We compared the cardiovascular risk in rheumatoid arthritis patients starting a TNF-¦Á blocking agent versus a nonbiologic disease-modifying antirheumatic drug (nbDMARD).

Methods

Subjects with rheumatoid arthritis participating in several different US insurance programs between 1998 and 2007 who received methotrexate were eligible. Those who added a TNF-¦Á blocking agent were compared with subjects who added a nbDMARD in Cox regression models stratified by propensity score decile and adjusted for oral glucocorticoid dosage. We examined the composite cardiovascular end point of myocardial infarction, stroke, or coronary re-vascularization after 6 months.

Results

We compared 8656 new users of a nbDMARD with 11,587 new users of a TNF-¦Á blocking agent with similar baseline covariates. Incidence rates per 100 person-years for the composite cardiovascular end point were 3.05 (95 % confidence interval [CI], 2.54-3.65) for nbDMARDs and 2.52 (95 % CI, 2.12-2.98) for TNF-¦Á blocking agents. The hazard ratio (HR) for the TNF-¦Á blocking agent compared with nbDMARD carrying the first exposure forward was 0.80 (95 % , CI 0.62-1.04), while the HR for the as-treated analysis was 0.71 (95 % CI, 0.52-0.97). The potential cardiovascular benefit of TNF-¦Á blocking agents was strongest among individuals ¡Ý65 years of age (HR 0.52; 95 % CI, 0.34 -0.77; P for interaction?= 0.075).

Conclusion

Among subjects with rheumatoid arthritis, TNF-¦Á blocking agents may be associated with a reduced risk of cardiovascular events compared with an nbDMARD. Randomized controlled clinical trials should be considered to test this hypothesis.