Antirheumatic drug use and the risk of acute myocardial infarction
Antirheumatic drug use and the risk of acute myocardial infarction
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DOI：
10.1002/art.22094
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发表时间：
2006-08-15
期刊：
影响因子：
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通讯作者：
Hudson, Marie
中科院分区：
文献类型：
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作者：
Suissa, Samy;Bernatsky, Sasha;Hudson, Marie
Objective.评估急性心肌梗死（AMI）与使用疾病缓解抗风湿药物（DMARDs）和其他类风湿关节炎（RA）常用药物相关的风险。我们在1999年至2003年期间观察到的RA受试者队列中进行了巢式病例对照分析，这些受试者是从Pharmacopoeia索赔数据库中确定的。对于随访期间确定的首次AMI住院，从队列中随机选择10名在性别、年龄和进入研究时间上匹配的对照组。采用条件Logistic回归分析，在校正AMI危险因素后，根据处方药测量，估计与当前使用抗RA治疗相关的AMI发生率比（RR）。该队列包括107，908例受试者（入组时平均年龄54岁）。在随访期间，发生了558例AMI病例（每年每1,000例中有3.4例）。当前使用任何DMARD均可显着降低AMI发生率（调整后的RR 0.80，95%置信区间[95%CI] 0.65-0.98）。这种效应在所有DNIARDs中一致，包括甲氨蝶呤（RR 0.81，95% CI 0.60-1.08）、来氟米特（RR 0.28，95% CI 0.12-0.65）和其他传统DMARD（RR 0.67，95% CI 0.46-0.97），但不包括生物制剂（RR 1.30，95% CI 0.92-1.83）。使用糖皮质激素可增加AMI的发生率（RR 1.32，95%CI 1.02-4.72），而非选择性非甾体类抗炎药（RR 1.05，95%CI 0.81-1.36）或环氧化酶2（考克斯-2）抑制剂（RR 1.11，95%CI 0.87-1.43）则无此作用。DMARD使用与RA住院患者AMI风险降低相关。在该人群中未发现考克斯-2抑制剂的风险增加。
Objective. To assess the risk of acute myocardial infarction (AMI) associated with the use of disease-modifying antirheurnatic drugs (DMARDs) and other medications commonly used in rheumatoid arthritis (RA).Methods. We conducted a nested case-control analysis within a cohort of subjects with RA, observed between 1999 and 2003, identified from the PharMetrics claims database. For each first AMI hospitalization identified during followup, 10 controls matched on sex, age, and time of study entry were randomly selected from the cohort. Conditional logistic regression was used to estimate the rate ratio (RR) of AMI associated with the current use of anti-RA therapy, as measured from dispensed prescriptions, after adjustment for AMI risk factors.Results. The cohort included 107,908 subjects (average age 54 years at cohort entry). During followup, 558 AMI cases occurred (3.4 per 1,000 per year). AMI rate was significantly decreased with the current use of any DMARD (adjusted RR 0.80, 95% confidence interval [95% CI] 0.65-0.98). This effect was consistent across all DNIARDs, including methotrexate (RR 0.81, 95% CI 0.60-1.08), leflunomide (RR 0.28, 95% CI 0.12-0.65), and other traditional DMARDs (RR 0.67, 95% CI 0.46-0.97), but not biologic agents (RR 1.30, 95% CI 0.92-1.83). AMI rate increased with the use of glucocorticoids (RR 1.32, 95% CI 1.02-4.72) but not with nonselective nonsteroidal antiinflammatory drugs (RR 1.05, 95% Cl 0.81-1.36) or cyclooxygenase 2 (COX-2) inhibitors (RR 1.11, 95% CI 0.87-1.43).Conclusion. DMARD use is associated with a reduction in AMI risk inpatients with RA. No risk increase was found with the COX-2 inhibitors in this population.