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Cardiovascular Risk in Rheumatoid Arthritis: Comparing TNF-α Blockade with Nonbiologic DMARDs
Open accessAbstract
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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“treatment with TNF inhibitors in rheumatoid arthritis, an overt inflammatory disease, is associated with a decreased risk of cardiovascular events”
From Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty (2018) · cites this paper as [184]
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Metadata
- 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
- 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)
- 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
- 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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