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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

Cardiovascular hazard reduction associated with longer anti-TNF exposure (MTX, methotrexate; TNF, tumour necrosis factor).
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RMDOPEN2015000080F2: Cardiovascular hazard reduction associated with longer anti-TNF exposure (MTX, methotrexate; TNF, tumour necrosis factor).

Mentions: The model predicted that cumulative use of 1, 2 or 3 years of anti-TNF+MTX treatment would reduce the cardiovascular event risks by 21%, 38% and 51%, respectively, compared to use of MTX alone during those time periods, adjusting for baseline characteristics and concurrent use of other DMARDs and corticosteroids (figure 2). Predicted cumulative incidence curves for continuous treatment with anti-TNF+MTX or with MTX are shown in figure 3. On the log-hazard scale, no significant interaction was detected between effects on cardiovascular risk of exposure to anti-TNF and exposure to MTX. This indicates that anti-TNF combination therapy and anti-TNF monotherapy are associated with similar levels of cardiovascular risk reduction, which is greater than that associated with MTX monotherapy.


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)

Cardiovascular hazard reduction associated with longer anti-TNF exposure (MTX, methotrexate; TNF, tumour necrosis factor).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

RMDOPEN2015000080F2: Cardiovascular hazard reduction associated with longer anti-TNF exposure (MTX, methotrexate; TNF, tumour necrosis factor).
Mentions: The model predicted that cumulative use of 1, 2 or 3 years of anti-TNF+MTX treatment would reduce the cardiovascular event risks by 21%, 38% and 51%, respectively, compared to use of MTX alone during those time periods, adjusting for baseline characteristics and concurrent use of other DMARDs and corticosteroids (figure 2). Predicted cumulative incidence curves for continuous treatment with anti-TNF+MTX or with MTX are shown in figure 3. On the log-hazard scale, no significant interaction was detected between effects on cardiovascular risk of exposure to anti-TNF and exposure to MTX. This indicates that anti-TNF combination therapy and anti-TNF monotherapy are associated with similar levels of cardiovascular risk reduction, which is greater than that associated with MTX monotherapy.

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