No increased mortality in patients with rheumatoid arthritis treated with biologics: results from the biologics register of six rheumatology institutes in Japan

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• 作者：Ayako Nakajima ; Kazuyoshi Saito ; Toshihisa Kojima ; Koichi Amano…
• 关键词：Biologics ; Cause of death ; Mortality ; Rheumatoid arthritis ; Standardized mortality ratio
• 刊名：Modern Rheumatology
• 出版年：2013
• 出版时间：September 2013
• 年：2013
• 卷：23
• 期：5
• 页码：945-952
• 全文大小：193KB
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• 作者单位：Ayako Nakajima (1)
  Kazuyoshi Saito (2)
  Toshihisa Kojima (3)
  Koichi Amano (4)
  Taku Yoshio (6)
  Wataru Fukuda (7)
  Eisuke Inoue (1)
  Atsuo Taniguchi (1)
  Shigeki Momohara (1)
  Seiji Minota (6)
  Tsutomu Takeuchi (4) (5)
  Naoki Ishiguro (3)
  Yoshiya Tanaka (2)
  Hisashi Yamanaka (1)
  
  1. Institute of Rheumatology, Tokyo Women’s Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-054, Japan
  2. The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
  3. Department of Orthopedic Surgery and Rheumatology, Nagoya University, Nagoya, Japan
  4. Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  6. Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi, Japan
  7. Endocrinology and Rheumatology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
  5. Department of Internal Medicine, Division of Rheumatology, Keio University, Tokyo, Japan
  
• ISSN：1439-7609

文摘

Objective To investigate the influence of biologics on mortality and risk factors for death in rheumatoid arthritis (RA) patients. Methods RA patients treated with at least one dose of biologics in daily practice in six large rheumatology institutes (“biologics cohort- were observed until 15 May 2010 or death, whichever occurred first. Mortality of the biologics cohort and the “comparator cohort-(comprising patients among the IORRA cohort who had never been treated with biologics) was compared to that of the Japanese general population. Factors associated with mortality were assessed by a Cox model. Results Among 2683 patients with 6913.0 patient-years of observation, 38 deaths were identified in the biologics cohort. The probability of death in patients lost to follow-up, calculated using the weighted standardized mortality ratio (SMR), was 1.08 [95?% confidence interval (CI) 0.77-.47] in the biologics cohort and 1.28 (95?% CI 1.17-.41) in the comparator cohort. Pulmonary involvement was the main cause of death (47.4?%), and the disease-specific SMR of pneumonia was 4.19 (95?% CI 1.81-.25). Risk factors for death included male gender [hazard ratio (HR) 2.78 (95?% CI 1.24-.22)], advanced age (HR 1.07, 95?% CI 1.03-.11), and corticosteroid dose (HR 1.08, 95?% CI 1.01-.17). Conclusion Mortality in RA patients exposed to biologics did not exceed that in patients not exposed to biologics, but death from pulmonary manifestations was proportionally increased in RA patients exposed to biologics.