Cargando…

No Evidence of Association Between Anti–Tumor Necrosis Factor Treatment and Mortality in Patients With Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register

OBJECTIVE: To study the association between anti–tumor necrosis factor (anti-TNF) therapy and mortality in a national cohort of patients with rheumatoid arthritis. METHODS: We prospectively followed up 12,672 patients who were beginning anti-TNF therapy and 3,522 biologic-naive patients receiving di...

Descripción completa

Detalles Bibliográficos
Autores principales: Lunt, Mark, Watson, Kath D, Dixon, William G, Symmons, Deborah P M, Hyrich, Kimme L
Formato: Texto
Lenguaje:English
Publicado: Wiley Subscription Services, Inc., A Wiley Company 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3061010/
https://www.ncbi.nlm.nih.gov/pubmed/20662063
http://dx.doi.org/10.1002/art.27660
_version_ 1782200569855737856
author Lunt, Mark
Watson, Kath D
Dixon, William G
Symmons, Deborah P M
Hyrich, Kimme L
author_facet Lunt, Mark
Watson, Kath D
Dixon, William G
Symmons, Deborah P M
Hyrich, Kimme L
author_sort Lunt, Mark
collection PubMed
description OBJECTIVE: To study the association between anti–tumor necrosis factor (anti-TNF) therapy and mortality in a national cohort of patients with rheumatoid arthritis. METHODS: We prospectively followed up 12,672 patients who were beginning anti-TNF therapy and 3,522 biologic-naive patients receiving disease-modifying antirheumatic drugs (DMARDs) until either July 31, 2008, or death, whichever occurred first. Notification of death and cause of death was received from the UK National Death Register. Mortality was compared using Cox proportional hazards models. Inverse probability of treatment weighting was used to adjust for the confounding effects of baseline differences between groups, including age, sex, disease severity, disability, and comorbidity. Missing baseline data were accounted for using multiple imputation. RESULTS: When compared with the DMARD cohort, the anti-TNF cohort was younger (median age 57 years versus 61 years), had greater disease activity (median Disease Activity Score in 28 joints 6.6 versus 5.1), and had greater disability (median Health Assessment Questionnaire score 2.1 versus 1.6). Patients in the DMARD cohort were more likely to have a history of myocardial infarction (4.8% versus 3.1%) and chronic obstructive pulmonary disease (8.1% versus 4.8%) but were less likely to have had depression (16.5% versus 18.9%). There were 9,445 and 50,803 person-years of followup in the DMARD and anti-TNF cohorts, respectively, during which time 204 DMARD-treated and 856 anti-TNF–treated patients died. The weighted mortality hazard ratios in the anti-TNF cohort were as follows: all-cause 0.86 (95% confidence interval [95% CI] 0.64–1.16), circulatory disease 0.73 (95% CI 0.44–1.23), neoplasm 0.65 (95% CI 0.39–1.09), and respiratory disease 0.81 (95% CI 0.36–1.83). CONCLUSION: Our results indicate that, compared with standard DMARD therapy, treatment with anti-TNF therapies was not associated with an increase in mortality.
format Text
id pubmed-3061010
institution National Center for Biotechnology Information
language English
publishDate 2010
publisher Wiley Subscription Services, Inc., A Wiley Company
record_format MEDLINE/PubMed
spelling pubmed-30610102011-03-25 No Evidence of Association Between Anti–Tumor Necrosis Factor Treatment and Mortality in Patients With Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register Lunt, Mark Watson, Kath D Dixon, William G Symmons, Deborah P M Hyrich, Kimme L Arthritis Rheum Rheumatoid Arthritis OBJECTIVE: To study the association between anti–tumor necrosis factor (anti-TNF) therapy and mortality in a national cohort of patients with rheumatoid arthritis. METHODS: We prospectively followed up 12,672 patients who were beginning anti-TNF therapy and 3,522 biologic-naive patients receiving disease-modifying antirheumatic drugs (DMARDs) until either July 31, 2008, or death, whichever occurred first. Notification of death and cause of death was received from the UK National Death Register. Mortality was compared using Cox proportional hazards models. Inverse probability of treatment weighting was used to adjust for the confounding effects of baseline differences between groups, including age, sex, disease severity, disability, and comorbidity. Missing baseline data were accounted for using multiple imputation. RESULTS: When compared with the DMARD cohort, the anti-TNF cohort was younger (median age 57 years versus 61 years), had greater disease activity (median Disease Activity Score in 28 joints 6.6 versus 5.1), and had greater disability (median Health Assessment Questionnaire score 2.1 versus 1.6). Patients in the DMARD cohort were more likely to have a history of myocardial infarction (4.8% versus 3.1%) and chronic obstructive pulmonary disease (8.1% versus 4.8%) but were less likely to have had depression (16.5% versus 18.9%). There were 9,445 and 50,803 person-years of followup in the DMARD and anti-TNF cohorts, respectively, during which time 204 DMARD-treated and 856 anti-TNF–treated patients died. The weighted mortality hazard ratios in the anti-TNF cohort were as follows: all-cause 0.86 (95% confidence interval [95% CI] 0.64–1.16), circulatory disease 0.73 (95% CI 0.44–1.23), neoplasm 0.65 (95% CI 0.39–1.09), and respiratory disease 0.81 (95% CI 0.36–1.83). CONCLUSION: Our results indicate that, compared with standard DMARD therapy, treatment with anti-TNF therapies was not associated with an increase in mortality. Wiley Subscription Services, Inc., A Wiley Company 2010-11 /pmc/articles/PMC3061010/ /pubmed/20662063 http://dx.doi.org/10.1002/art.27660 Text en Copyright © 2010 American College of Rheumatology http://creativecommons.org/licenses/by/2.5/ Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.
spellingShingle Rheumatoid Arthritis
Lunt, Mark
Watson, Kath D
Dixon, William G
Symmons, Deborah P M
Hyrich, Kimme L
No Evidence of Association Between Anti–Tumor Necrosis Factor Treatment and Mortality in Patients With Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register
title No Evidence of Association Between Anti–Tumor Necrosis Factor Treatment and Mortality in Patients With Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register
title_full No Evidence of Association Between Anti–Tumor Necrosis Factor Treatment and Mortality in Patients With Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register
title_fullStr No Evidence of Association Between Anti–Tumor Necrosis Factor Treatment and Mortality in Patients With Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register
title_full_unstemmed No Evidence of Association Between Anti–Tumor Necrosis Factor Treatment and Mortality in Patients With Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register
title_short No Evidence of Association Between Anti–Tumor Necrosis Factor Treatment and Mortality in Patients With Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register
title_sort no evidence of association between anti–tumor necrosis factor treatment and mortality in patients with rheumatoid arthritis: results from the british society for rheumatology biologics register
topic Rheumatoid Arthritis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3061010/
https://www.ncbi.nlm.nih.gov/pubmed/20662063
http://dx.doi.org/10.1002/art.27660
work_keys_str_mv AT luntmark noevidenceofassociationbetweenantitumornecrosisfactortreatmentandmortalityinpatientswithrheumatoidarthritisresultsfromthebritishsocietyforrheumatologybiologicsregister
AT watsonkathd noevidenceofassociationbetweenantitumornecrosisfactortreatmentandmortalityinpatientswithrheumatoidarthritisresultsfromthebritishsocietyforrheumatologybiologicsregister
AT dixonwilliamg noevidenceofassociationbetweenantitumornecrosisfactortreatmentandmortalityinpatientswithrheumatoidarthritisresultsfromthebritishsocietyforrheumatologybiologicsregister
AT symmonsdeborahpm noevidenceofassociationbetweenantitumornecrosisfactortreatmentandmortalityinpatientswithrheumatoidarthritisresultsfromthebritishsocietyforrheumatologybiologicsregister
AT hyrichkimmel noevidenceofassociationbetweenantitumornecrosisfactortreatmentandmortalityinpatientswithrheumatoidarthritisresultsfromthebritishsocietyforrheumatologybiologicsregister
AT noevidenceofassociationbetweenantitumornecrosisfactortreatmentandmortalityinpatientswithrheumatoidarthritisresultsfromthebritishsocietyforrheumatologybiologicsregister
AT noevidenceofassociationbetweenantitumornecrosisfactortreatmentandmortalityinpatientswithrheumatoidarthritisresultsfromthebritishsocietyforrheumatologybiologicsregister