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Longer durations of antitumour necrosis factor treatment are associated with reduced risk of cardiovascular events in patients with rheumatoid arthritis.

Nurmohamed M, Bao Y, Signorovitch J, Trahey A, Mulani P, Furst DE - RMD Open (2015)

Bottom Line: Each additional 6 months of anti-TNF therapy use versus non-use reduced the risk (HR; 95% CI) for any cardiovascular event by 12% (0.88; 0.81 to 0.95, p=0.002).Anti-TNF therapy was associated with a 13% and 12% reduction in cardiovascular events in patients aged ≥50 years (0.87; 0.80 to 0.95, p=0.002) and in those without prior methotrexate use (0.88; 0.78 to 0.99, p=0.04), respectively.Cumulative use of 1, 2 or 3 years of anti-TNF therapy versus non-use is expected to reduce cardiovascular event risks by 21%, 38% and 51%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Departments of Internal Medicine and Rheumatology , VU University Medical Centre , Amsterdam , The Netherlands.

ABSTRACT

Objective: To assess the effects of treatment with antitumour necrosis factor (TNF) agents, methotrexate, or other non-biological disease-modifying antirheumatic drugs (DMARDs) on cardiovascular event risks among patients with rheumatoid arthritis (RA).

Methods: We conducted a retrospective study using data from the MarketScan claims database. Patients with RA with ≥1 prescription for an index drug were included. Each patient's use of an index drug was calculated cumulatively as a time-varying exposure. The incidence of cardiovascular events among patients with RA was determined. Associations between drug exposures and occurrence of cardiovascular events were assessed with Cox proportional hazards models.

Results: Of 113 677 patients identified, 35.8%, 41.1% and 23.1% received anti-TNF agents, methotrexate and other DMARDs, respectively. Patients were treated for an average of 7.6 months; 2138 patients (1.9%) had a cardiovascular event following their index prescription. Each additional 6 months of anti-TNF therapy use versus non-use reduced the risk (HR; 95% CI) for any cardiovascular event by 12% (0.88; 0.81 to 0.95, p=0.002). Anti-TNF therapy was associated with a 13% and 12% reduction in cardiovascular events in patients aged ≥50 years (0.87; 0.80 to 0.95, p=0.002) and in those without prior methotrexate use (0.88; 0.78 to 0.99, p=0.04), respectively. Cumulative use of 1, 2 or 3 years of anti-TNF therapy versus non-use is expected to reduce cardiovascular event risks by 21%, 38% and 51%, respectively.

Conclusions: Anti-TNF therapy was associated with a significantly lower risk of cardiovascular events among patients with RA, older patients with RA and patients without prior exposure to methotrexate.

No MeSH data available.


Related in: MedlinePlus

HRs for composite cardiovascular events. (A) RA treatments, (B) anti-TNF treatment in subpopulations. *Adjusted for baseline demographics, comorbidities, prior cardiovascular events, RA medications and cardiovascular-related medications (DMARD, disease-modifying antirheumatic drug; MTX, methotrexate; RA, rheumatoid arthritis; TNF, tumour necrosis factor).
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RMDOPEN2015000080F1: HRs for composite cardiovascular events. (A) RA treatments, (B) anti-TNF treatment in subpopulations. *Adjusted for baseline demographics, comorbidities, prior cardiovascular events, RA medications and cardiovascular-related medications (DMARD, disease-modifying antirheumatic drug; MTX, methotrexate; RA, rheumatoid arthritis; TNF, tumour necrosis factor).

Mentions: In the adjusted Cox models, each additional 6 months of anti-TNF treatment was significantly associated with a 12% reduction in cardiovascular event risk (HR 0.88, 95% CI 0.81 to 0.95, p=0.002; figure 1A). In addition to adjusting for patient baseline characteristics, this analysis adjusted for cumulative exposures to MTX, other non-biologic DMARDs and corticosteroids during the study period. Use of MTX or other DMARDs was not significantly associated with a significant reduction in cardiovascular event risk (figure 1A). However, each additional 6 months of treatment with corticosteroids was associated with a 7% increase in the risk of cardiovascular events (HR 1.07, 95% CI 1.03 to 1.10, p<0.001). It is worth noting that the three exposure groups into which patients were hierarchically classified for tables 1 and 2 are not included in this time-to-event analysis, where cumulative exposures to each type of treatment were measured separately to reflect real-world use.


Longer durations of antitumour necrosis factor treatment are associated with reduced risk of cardiovascular events in patients with rheumatoid arthritis.

Nurmohamed M, Bao Y, Signorovitch J, Trahey A, Mulani P, Furst DE - RMD Open (2015)

HRs for composite cardiovascular events. (A) RA treatments, (B) anti-TNF treatment in subpopulations. *Adjusted for baseline demographics, comorbidities, prior cardiovascular events, RA medications and cardiovascular-related medications (DMARD, disease-modifying antirheumatic drug; MTX, methotrexate; RA, rheumatoid arthritis; TNF, tumour necrosis factor).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612693&req=5

RMDOPEN2015000080F1: HRs for composite cardiovascular events. (A) RA treatments, (B) anti-TNF treatment in subpopulations. *Adjusted for baseline demographics, comorbidities, prior cardiovascular events, RA medications and cardiovascular-related medications (DMARD, disease-modifying antirheumatic drug; MTX, methotrexate; RA, rheumatoid arthritis; TNF, tumour necrosis factor).
Mentions: In the adjusted Cox models, each additional 6 months of anti-TNF treatment was significantly associated with a 12% reduction in cardiovascular event risk (HR 0.88, 95% CI 0.81 to 0.95, p=0.002; figure 1A). In addition to adjusting for patient baseline characteristics, this analysis adjusted for cumulative exposures to MTX, other non-biologic DMARDs and corticosteroids during the study period. Use of MTX or other DMARDs was not significantly associated with a significant reduction in cardiovascular event risk (figure 1A). However, each additional 6 months of treatment with corticosteroids was associated with a 7% increase in the risk of cardiovascular events (HR 1.07, 95% CI 1.03 to 1.10, p<0.001). It is worth noting that the three exposure groups into which patients were hierarchically classified for tables 1 and 2 are not included in this time-to-event analysis, where cumulative exposures to each type of treatment were measured separately to reflect real-world use.

Bottom Line: Each additional 6 months of anti-TNF therapy use versus non-use reduced the risk (HR; 95% CI) for any cardiovascular event by 12% (0.88; 0.81 to 0.95, p=0.002).Anti-TNF therapy was associated with a 13% and 12% reduction in cardiovascular events in patients aged ≥50 years (0.87; 0.80 to 0.95, p=0.002) and in those without prior methotrexate use (0.88; 0.78 to 0.99, p=0.04), respectively.Cumulative use of 1, 2 or 3 years of anti-TNF therapy versus non-use is expected to reduce cardiovascular event risks by 21%, 38% and 51%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Departments of Internal Medicine and Rheumatology , VU University Medical Centre , Amsterdam , The Netherlands.

ABSTRACT

Objective: To assess the effects of treatment with antitumour necrosis factor (TNF) agents, methotrexate, or other non-biological disease-modifying antirheumatic drugs (DMARDs) on cardiovascular event risks among patients with rheumatoid arthritis (RA).

Methods: We conducted a retrospective study using data from the MarketScan claims database. Patients with RA with ≥1 prescription for an index drug were included. Each patient's use of an index drug was calculated cumulatively as a time-varying exposure. The incidence of cardiovascular events among patients with RA was determined. Associations between drug exposures and occurrence of cardiovascular events were assessed with Cox proportional hazards models.

Results: Of 113 677 patients identified, 35.8%, 41.1% and 23.1% received anti-TNF agents, methotrexate and other DMARDs, respectively. Patients were treated for an average of 7.6 months; 2138 patients (1.9%) had a cardiovascular event following their index prescription. Each additional 6 months of anti-TNF therapy use versus non-use reduced the risk (HR; 95% CI) for any cardiovascular event by 12% (0.88; 0.81 to 0.95, p=0.002). Anti-TNF therapy was associated with a 13% and 12% reduction in cardiovascular events in patients aged ≥50 years (0.87; 0.80 to 0.95, p=0.002) and in those without prior methotrexate use (0.88; 0.78 to 0.99, p=0.04), respectively. Cumulative use of 1, 2 or 3 years of anti-TNF therapy versus non-use is expected to reduce cardiovascular event risks by 21%, 38% and 51%, respectively.

Conclusions: Anti-TNF therapy was associated with a significantly lower risk of cardiovascular events among patients with RA, older patients with RA and patients without prior exposure to methotrexate.

No MeSH data available.


Related in: MedlinePlus