Document Detail

Cardiovascular risk in rheumatoid arthritis: comparing TNF-α blockade with nonbiologic DMARDs.
MedLine Citation:
PMID:  23885678     Owner:  NLM     Status:  MEDLINE    
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.
Daniel H Solomon; Jeffrey R Curtis; Kenneth G Saag; Joyce Lii; Lang Chen; Leslie R Harrold; Lisa J Herrinton; David J Graham; Mary K Kowal; Bindee Kuriya; Liyan Liu; Marie R Griffin; James D Lewis; Jeremy A Rassen
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The American journal of medicine     Volume:  126     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-26     Completed Date:  2013-09-23     Revised Date:  2014-07-25    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  730.e9-730.e17     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Antirheumatic Agents / therapeutic use*
Arthritis, Rheumatoid / complications,  drug therapy*
Cardiovascular Diseases / complications,  prevention & control*
Cohort Studies
Kaplan-Meier Estimate
Methotrexate / therapeutic use*
Middle Aged
Myocardial Infarction / prevention & control
Myocardial Revascularization
Proportional Hazards Models
Retrospective Studies
Stroke / prevention & control
Treatment Outcome
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Grant Support
1U18 HSO17919-0//PHS HHS
Reg. No./Substance:
0/Antirheumatic Agents; 0/Tumor Necrosis Factor-alpha; YL5FZ2Y5U1/Methotrexate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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