Treatment with TNF blockers and mortality risk in patients with rheumatoid arthritis

Abstract

Objective: To assess mortality in patients with rheumatoid arthritis (RA) treated with tumour necrosis factor (TNF) inhibitors, compared with a standard RA population. Methods: Patients were recruited from a regional register, which includes over 90% of patients with RA treated with TNF blockers in the area in 1999 or later, and a local community-based cohort of patients with RA, established in 1997. Of a total of 1430 patients in the combined cohort ,80 years old, 921 received treatment with TNF inhibitors during the study period. The total cohort was linked with the national register for cause of death. Overall mortality in those treated versus those not treated with TNF blockers was estimated using standardised mortality ratios and time-dependent Cox proportional hazards. Results: There were 188 deaths per 7077 person-years at risk in the total cohort. Controlling for age, sex, disability and baseline comorbidity, the adjusted HR for death was 0.65 (95% CI 0.46 to 0.93) in those treated with anti-TNF versus those not treated. The effect was significant in women (HR = 0.52, 95% CI 0.33 to 0.82) but not in men (HR = 0.95, 95% CI 0.52 to 1.71). Conclusion: After adjusting for disease severity, treatment with TNF inhibitors was found to be associated with a reduced mortality in women but not men with RA. These findings are compatible with a critical role for inflammation in RA-associated premature mortality.

How many life years are lost in patients with rheumatoid arthritis? Secular cause‐specific and all‐cause mortality in rheumatoid arthritis, and their predictors in a long‐term Australian cohort study

“…16 However, large, long-term international bDMARD cohorts have published early data on the relationship between TNF-a treatment and mortality. 17,18 The South Swedish Arthritis Treatment Group (established in 1999) registry and the British Society for Rheumatology Biologics Register (BSRBR, established in 2001) examined whether TNF-a inhibitor treatment was associated with increased mortality compared with patients on conventional DMARD. The Swedish group found that after adjusting for functional disability and comorbidity, treatment with TNF-a inhibitors versus those not treated was associated with a reduced mortality (hazard ratio for death was 0.65 (95% CI 0.46, 0.93)).…”

Systemic treatment and narrowband ultraviolet B differentially affect cardiovascular risk markers in psoriasis

“…37 Systemic therapy has an effect on cardiocascular risk in both rheumatoid arthritis and psoriasis, both with systemic biological therapy and methotrexate. 38,39 In psoriasis, methotrexate downregulates the expression of the membranebound isoforms of ICAM-1, VCAM-1 and E-selectin in the skin. 21 Furthermore, the therapy decreases the soluble form of E-selectin in serum from patients with the autoimmune skin disease bullous pemphigoid.…”

Perfil de utilización de los anti-factor de necrosis tumoral en pacientes de Colombia

“…Los medicamentos inhibidores del factor de necrosis tumoral (anti-TNF) se recomiendan para el tratamiento de artritis reumatoide grave activa, después de que una adecuada utilización de antirreumáticos modificadores de la enfermedad ha fallado, en espondilitis anquilosante, artritis reumatoide juvenil y artritis psoriásica resistente a los fármacos convencionales, y para el manejo de la enfermedad de Crohn de moderada a grave, en pacientes que responden en forma inadecuada a los tratamientos clásicos (10)(11)(12)(13).…”