Cited by 112Rheumatoid Arthritis Research and TherapiesAutoimmune and Inflammatory Disorders ResearchInflammatory mediators and NSAID effects

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Cardiovascular Risk in Rheumatoid Arthritis: Comparing TNF-α Blockade with Nonbiologic DMARDs

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Solomon, Daniel H., Curtis, Jeffrey R., Saag, Kenneth G., Lii, Joyce, Chen, Lang, Harrold, Leslie R., Herrinton, Lisa J., Graham, David J., Kowal, Mary K., Kuriya, Bindee, Liu, Liyan, Griffin, Marie R., Lewis, James D., Rassen, Jeremy A.·2013·The American Journal of Medicine

DOI 10.1016/j.amjmed.2013.02.016PMC PMC4674813

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Abstract

Background Elevated tumor necrosis factor (TNF)-α likely contributes to the excess cardiovascular risk observed in rheumatoid arthritis. We compared the cardiovascular risk in rheumatoid arthritis patients starting a TNF-α blocking agent versus a nonbiologic disease-modifying antirheumatic drug (nbDMARD).Methods Subjects with rheumatoid arthritis participating in several different US insurance programs between 1998 and 2007 who received methotrexate were eligible. Those who added a TNF-α blocking agent were compared with subjects who added a nbDMARD in Cox regression models stratified by propensity score decile and adjusted for oral glucocorticoid dosage. We examined the composite cardiovascular end point of myocardial infarction, stroke, or coronary re-vascularization after 6 months.Results We compared 8656 new users of a nbDMARD with 11,587 new users of a TNF-α blocking agent with similar baseline covariates. Incidence rates per 100 person-years for the composite cardiovascular end point were 3.05 (95% confidence interval [CI], 2.54-3.65) for nbDMARDs and 2.52 (95% CI, 2.12-2.98) for TNF-α blocking agents. The hazard ratio (HR) for the TNF-α blocking agent compared with nbDMARD carrying the first exposure forward was 0.80 (95%, CI 0.62-1.04), while the HR for the as-treated analysis was 0.71 (95% CI, 0.52-0.97). The potential cardiovascular benefit of TNF-α blocking agents was strongest among individuals ≥65 years of age (HR 0.52; 95% CI, 0.34 -0.77; P for interaction = 0.075).Conclusion Among subjects with rheumatoid arthritis, TNF-α blocking agents may be associated with a reduced risk of cardiovascular events compared with an nbDMARD. Randomized controlled clinical trials should be considered to test this hypothesis.

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Authors: Solomon, D. H., Curtis, J. R., Saag, K. G., Lii, J., Chen, L., Harrold, L. R., Herrinton, L. J., Graham, D. J., Kowal, M. K., Kuriya, B., Liu, L., Griffin, M. R., Lewis, J. D., & Rassen, J. A.
Affiliations: Brigham and Women's Hospital (US)
University of Alabama at Birmingham (US)
University of Massachusetts Chan Medical School (US)
Kaiser Permanente (US)
United States Food and Drug Administration (US)
University of Toronto (CA)
Vanderbilt University (US)
University of Pennsylvania (US)
Corresponding author: Solomon, Daniel H.
ORCID: Solomon, Daniel H.
Curtis, Jeffrey R.
Saag, Kenneth G.
Harrold, Leslie R.
Herrinton, Lisa J.
Graham, David J.
Kuriya, Bindee
Liu, Liyan
Griffin, Marie R.
Lewis, James D.
Rassen, Jeremy A.
Venue: The American Journal of Medicine
Publisher: Elsevier BV
Published: 2013-08
Volume: 126
Issue: 8
Pages: 730.e9-730.e17
ISSN: 0002-9343 (ISSN-L)
DOI: 10.1016/j.amjmed.2013.02.016
PMC: PMC4674813
OpenAlex: W1995953874
Cited by: 111
References: 42
Citations by year: 2026: 1 · 2025: 1 · 2024: 11 · 2023: 10 · 2022: 11 · 2021: 3 · 2020: 6 · 2019: 5 · 2018: 10 · 2017: 12 · 2016: 11 · 2015: 12 · 2014: 14 · 2013: 4
FWCI: 11.18
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The American Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: U.S. Food and Drug Administration
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services (1U18 HSO17919-0)
Topics: Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
Health Sciences › Medicine › Hematology › Autoimmune and Inflammatory Disorders Research
Health Sciences › Medicine › Pharmacology (medical) › Inflammatory mediators and NSAID effects
Keywords: rheumatoid arthritis, cardiovascular risk, TNF-alpha blockade, methotrexate, myocardial infarction, stroke, coronary revascularization, cardiovascular events, older adults, propensity score matching
MeSH terms: Adult, Aged, Arthritis, Rheumatoid, Cardiovascular Diseases, Female, Humans, Male, Methotrexate, Middle Aged, Myocardial Infarction, Myocardial Revascularization, Retrospective Studies, Risk, Tumor Necrosis Factor-alpha, Cohort Studies, Proportional Hazards Models, Treatment Outcome, Antirheumatic Agents, Stroke, Kaplan-Meier Estimate

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Cardiovascular Risk in Rheumatoid Arthritis: Comparing TNF-α Blockade with Nonbiologic DMARDs

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