Tumor Necrosis Factor α Inhibitor Use and Decreased Risk for Incident Coronary Events in Rheumatoid Arthritis
Tumor Necrosis Factor α Inhibitor Use and Decreased Risk for Incident Coronary Events in Rheumatoid Arthritis
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DOI：
10.1002/acr.22166
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发表时间：
2014-03-01
影响因子：
4.7
通讯作者：
Wasko, Mary Chester M.
中科院分区：
文献类型：
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作者：
Bili, Androniki;Tang, Xiaoqin;Wasko, Mary Chester M.
目的确定肿瘤坏死因子 (TNF) 抑制剂与类风湿性关节炎 (RA) 患者心血管疾病 (CVD) 风险之间的关系。方法建立了 2,101 例 RA 患者的回顾性队列。药物暴露分为以下几组： 单独使用 TNF 抑制剂或与甲氨蝶呤联合使用（MTX；aTNF 组）；单独使用 MTX 或与其他非生物缓解病情抗风湿药物联合使用（DMARD；MTX 组）；且不含 MTX、非生物 DMARD（参考组）。主要结局是裁定的冠状动脉疾病（CAD），定义为心肌梗塞、不稳定心绞痛或冠状动脉血运重建手术。次要结局是判定的心血管疾病事件，定义为 CAD、中风、短暂性脑缺血发作、腹主动脉瘤、外周动脉疾病或动脉血运重建手术的综合结果。使用 Cox 回归模型计算 aTNF 和 MTX 组与参考组相比的 CAD 和 CVD 风险比。结果 共发生 46 起 CAD 事件和 82 起 CVD 事件。调整与 CAD 和 CVD 相关的协变量后，与参考组相比，aTNF 组发生 CAD 的风险比为 0.45（95% 置信区间 [95% CI] 0.21-0.96），MTX 组为 0.54（95% CI 0.27-1.09）。与参考组相比，使用 TNF 抑制剂超过 16.1 个月的 CAD 相对风险为 0.18（95% CI 0.06-0.50），CVD 相对风险为 0.31（95% CI 0.15-0.65）。 MTX 组也出现了类似但不显着的趋势。结论 TNF 抑制剂的使用与 RA 中 CAD 风险降低相关；长期使用风险会进一步降低。在权衡这些药物的风险与益处时应考虑这一点。
ObjectiveTo determine the association of tumor necrosis factor (TNF) inhibitors with risk for cardiovascular disease (CVD) in rheumatoid arthritis (RA) patients.MethodsA retrospective cohort of 2,101 incident RA patients was established. Medication exposure was categorized into the following groups: TNF inhibitors alone or in combination with methotrexate (MTX; aTNF group); MTX alone or in combination with other nonbiologic disease-modifying antirheumatic drugs (DMARDs; MTX group); and no MTX, nonbiologic DMARDs (reference group). Primary outcome was adjudicated incident coronary artery disease (CAD), defined as myocardial infarction, unstable angina, or coronary revascularization procedure. Secondary outcome was adjudicated incident CVD, defined as a composite of CAD, stroke, transient ischemic attack, abdominal aortic aneurysm, peripheral arterial disease, or arterial revascularization procedure. Cox regression models were used to calculate the hazard ratio for CAD and CVD for the aTNF and MTX groups compared to the reference group.ResultsThere were 46 incident CAD and 82 incident CVD events. Adjusting for covariates associated with CAD and CVD, the hazard ratio for incident CAD was 0.45 (95% confidence interval [95% CI] 0.21-0.96) for the aTNF group and 0.54 (95% CI 0.27-1.09) for the MTX group compared to the reference group. Use of TNF inhibitors for >16.1 months was associated with a relative risk for CAD of 0.18 (95% CI 0.06-0.50) and for CVD of 0.31 (95% CI 0.15-0.65) compared to the reference group. A similar, although not significant, trend was seen with the MTX group.ConclusionUse of TNF inhibitors is associated with a decreased risk for CAD in RA; the risk decreases further with long-term use. This should be considered when weighing the risks versus benefits of these medications.