All-cause and cause-specific mortality in rheumatoid arthritis are not greater than expected when treated with tumour necrosis factor antagonists
All-cause and cause-specific mortality in rheumatoid arthritis are not greater than expected when treated with tumour necrosis factor antagonists
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DOI：
10.1136/ard.2006.067660
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发表时间：
2007-07-01
影响因子：
27.4
通讯作者：
Gomez-Reino, Juan J.
中科院分区：
文献类型：
--
作者：
Carmona, Loreto;Descalzo, Miguel Angel;Gomez-Reino, Juan J.
背景：类风湿性关节炎（RA）的死亡率增加，主要是因为心血管（CV）事件、癌症和感染。最近的数据表明，治疗与肿瘤坏死因子（TNF）拮抗剂可能会影响这一trends.Objective：评估是否治疗与TNF拮抗剂是与减少心血管事件，癌症和感染率，并在死亡率与RA患者治疗和不治疗与TNF antagonist.Methods：BIOBADASER是一个注册的积极长期随访的安全性生物治疗RA患者。它包括4459例接受TNF拮抗剂治疗的RA患者。EMECAR是一个外部RA队列（n = 789），旨在定义西班牙疾病的特征并评估合并症。估计并比较了CV事件、癌症和感染的发病密度（缺血性心脏病）。将标准化死亡率与一般人群的死亡率进行比较。倾向评分用于匹配队列的概率正在treated.Results：率CV和癌症事件是显着高于EMECAR比BIOBADASER（RR 5 - 7不同的CV事件，和RR 2.9的癌症），而严重感染率是显着较高的BIOBADASER（RR 1.6）。根据EMECAR，生物粘附剂的死亡率为0.32（0.20 - 0.53）所有死因，0.58（0.24 - 1.41）CV事件，0.52（0.21 - 1.29）感染和0.36结论：RA患者接受TNF拮抗剂治疗后，除感染外的其他并发症和死亡率并不高于预期。
Background: Mortality is increased in rheumatoid arthritis ( RA), mainly because of cardiovascular ( CV) events, cancer and infections. Recent data suggest that treatment with tumour necrosis factor ( TNF) antagonists may affect this trend.Objective: To assess whether treatment with TNF antagonists is associated with reduction in CV events, cancer and infection rates, and in mortality in patients with RA treated and not treated with TNF antagonists.Methods: BIOBADASER is a registry for active long- term follow- up of safety of biological treatments in patients with RA. It includes 4459 patients with RA treated with TNF antagonists. EMECAR is an external RA cohort ( n = 789) established to define the characteristics of the disease in Spain and to assess comorbidity. The incidence density ( ischaemic heart disease) of CV events, cancer and infections was estimated and compared. The standardised mortality ratio was compared with the rate in the general population. A propensity score was used to match cohorts by the probability of being treated.Results: Rates of CV and cancer events are significantly higher in EMECAR than in BIOBADASER ( RR 5 - 7 for different CV events, and RR 2.9 for cancer), whereas the rate of serious infections is significantly higher in BIOBADASER ( RR 1.6). Mortality ratio of BIOBADASER by EMECAR is 0.32 ( 0.20 - 0.53) for all causes of death, 0.58 ( 0.24 - 1.41) for CV events, 0.52 ( 0.21 - 1.29) for infection and 0.36 ( 0.10 - 1.30) for cancerrelated deaths.Conclusion: Morbidity, other than infection, and mortality are not higher than expected in patients with RA treated with TNF antagonists.