The effect of anti-rheumatic medications for coronary artery diseases risk in patients with rheumatoid arthritis might be changed over time: A nationwide population-based cohort study

Abstract

ObjectivesTo determine whether anti-rheumatic drug usage is associated with risk of coronary artery diseases (CAD) in incident Rheumatoid Arthritis (RA) patients.MethodsData were obtained from the Taiwan National Health Insurance Research Database. The study cohort comprised 6260 patients who were newly diagnosed with RA between 2001–2010. The study endpoint was occurrence of CAD according to the ICD-9-CM codes. We used the WHO Defined Daily Dose (DDD) as a tool to assess the drugs exposure. The Cox proportional hazards regression model was used to estimate the hazard ratio (HR) of disease after controlling for demographic and other co-morbidities. When the proportionality assumption is violated, a spline curve of the Scaled Schoenfeld residuals is fitted to demonstrate the estimated effect on CAD over time for drug usage.ResultsAmong RA patients, use of celecoxib, and etoricoxib was associated with significantly decreased incidence of CAD. The adjusted HR(95% CI) of CAD for low-dose celecoxib (DDD≦1) and high-dose user were 0.47(0.34, 0.65) and 0.37(0.24, 0.58) during the 4 year follow-up time; however, it became 0.98(0.70, 1.37) and1.29(0.85, 1.95). Adjusted HR(95% CI) of CAD for etoricoxib users remained 0.47(0.26, 0.84).ConclusionsThis study revealed association of decreased CAD risk in RA patients taking 2 different kinds of COX-2i in comparison with nonusers. The effect might be changed over time, after about 4 years.

Cardiovascular Risk of Nonsteroidal Anti‐inflammatory Drugs and Classical and Selective Cyclooxygenase‐2 Inhibitors: A Meta‐analysis of Observational Studies

“…114 Only 9 studies in our meta-analysis included patients with rheumatic conditions. 44,45,58,64,76,101,102,104,109 Our results showed a statistically significant CVR for these patients (RR, 1.28 [1.20-1.35]), similar to the increment showed in the main analysis.…”

“…However, it should be kept in mind that some inflammatory diseases, such as rheumatoid arthritis or ankylosing spondylitis, usually present with cardiovascular complications . Only 9 studies in our meta‐analysis included patients with rheumatic conditions . Our results showed a statistically significant CVR for these patients (RR, 1.28 [1.20‐1.35]), similar to the increment showed in the main analysis.…”

“…25 Twenty-eight studies estimated the effect of dose on the CVR. 12,[27][28][29][36][37][38]44,48,50,[53][54][55][56][57]59,63,64,69,74,82,[87][88][89]92,105,106,109 Results for each individual drug are shown in (Table 3).…”

Etoricoxib and Diclofenac Might Reduce the Risk of Dementia in Patients with Osteoarthritis: A Nation-Wide, Population-Based Retrospective Cohort Study

“…Besides, both etoricoxib and diclofenac might be associated with a reduced risk of dementia [12,13].…”

Spezielle Schmerztherapie bei rheumatischen Erkrankungen

“…Auch für chronisch-entzündliche Erkrankungen gilt ein proportional zur Entzündungsaktivität erhöhtes, aber im Vergleich zu den Vorgenannten, niedrigeres KV-Risiko. Dies zeigt sich etwa daran, dass NSAR das Risiko für ein KV Ereignis zumindest in einer Gruppe von Patienten mit rheumatoider Arthritis nicht weiter erhöhen [32,33].…”