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Treatment in rheumatoid arthritis and mortality risk in clinical practice: the role of biologic agents
L. Rodriguez-Rodriguez1, L. Leon2, J. Ivorra-Cortes3, A. Gómez4, J.R. Lamas5, E. Pato6, J.Á. Jover7, L. Abásolo8
- Department of Rheumatology and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Madrid, Spain.
- Department of Rheumatology and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Madrid; and Universidad Camilo José Cela, Madrid, Spain. lleon.hcsc@salud.madrid.org
- Department of Rheumatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
- Department of Rheumatology, Hospital Clínico San Carlos, Madrid, Spain.
- Department of Rheumatology and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Madrid, Spain.
- Department of Rheumatology, Hospital Clínico San Carlos, Madrid, Spain.
- Department of Rheumatology, Hospital Clínico San Carlos, Madrid; and Department of Medicine, Universidad Complutense, Madrid, Spain.
- Department of Rheumatology and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Madrid, Spain.
CER9344
2016 Vol.34, N°6
PI 1026, PF 1032
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PMID: 27749239 [PubMed]
Received: 15/02/2016
Accepted : 16/05/2016
In Press: 07/10/2016
Published: 28/11/2016
Abstract
OBJECTIVES:
To assess the mortality rate (MR) and the mortality risk of a rheumatoid arthritis (RA) inception cohort, with and without biologic agents (BAs). Other factors associated to mortality were also investigated.
METHODS:
Retrospective longitudinal study of RA patients, attending the rheumatology outpatient clinic of a tertiary Hospital (Madrid), collected over 5 years (2000–2004), and followed from the diagnosis of RA up to the patients’ death, lost to follow-up or September 2013. The dependent variable was death and the independent variable was exposure to BAs. Covariables: sociodemographic, clinical and therapy variables. MR was expressed per 1,000 patient-years with the 95% confidence interval [CI]. BA influence on MR was analysed by multivariable Cox models. Clinical and therapy variables were used in a time-dependent manner. The results are expressed in hazard ratio (HR) and [CI].
RESULTS:
We included 576 patients and 711 courses of therapy. 19.6% were taking BA, 86% disease-modifying anti-rheumatic drugs (DMARDs) (70% on methotrexate - MTX), and 12% were untreated. There were 133 deaths during 4,981.64 patient-years at risk. The MR for BA was 12.6 [6–26], for DMARDs was 22.3 [18.4–27.1], and for those without treatment was 89.1 [61.9–128.2]. The adjusted HR for mortality in those exposed to BA versus those not exposed was 0.75 [0.32–1.71]). Other variables independently associated with mortality were: age, rheumatoid factor, hospital admissions, Health Assessment Questionnaire (HAQ), and MTX use (HR: 0.44 [0.29–0.66]).
CONCLUSIONS:
BAs and standard DMARDs are more effective in decreasing mortality compared to no therapy. Patients exposed to Bas were not associated with a significant increase or decrease in mortality when compared to patients with non-biological DMARDs. The use of MTX remains the only drug that has independently shown a beneficial effect on mortality.