Document Detail

Heart failure risk among patients with rheumatoid arthritis starting a TNF antagonist.
MedLine Citation:
PMID:  23155221     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: While heart failure (HF) is associated with elevations in tumor necrosis factor (TNF)α, several trials of TNF antagonists showed no benefit and possibly worsening of disease in those with known severe HF. We studied the risk of new or recurrent HF among a group of patients receiving these agents to treat rheumatoid arthritis (RA).
METHODS: We used data from four different US healthcare programmes. Subjects with RA receiving methotrexate were eligible to enter the study cohort if they added or switched to a TNF antagonist or another non-biological disease modifying antirheumatic drug (nbDMARD). These groups were compared in Cox regression models stratified by propensity score decile and adjusted for oral glucocorticoid dosage, prior HF hospitalisations, and the use of loop diuretics.
RESULTS: We compared 8656 new users of a nbDMARD with 11 587 new users of a TNF antagonist with similar baseline covariates. The HR for the TNF antagonists compared with nbDMARD was 0.85 (95% CI 0.63 to 1.14). The HR was also not elevated in subjects with a history of HF. But, it was elevated prior to 2002 (HR 2.17, 95% CI 0.45 to 10.50, test for interaction p=0.036). Oral glucocorticoids were associated with a dose-related gradient of HF risk: compared with no use, 1≤5 mg HR 1.30 (95% CI 0.91 to 1.85), ≥5 mg HR 1.54 (95% CI 1.09 to 2.19).
CONCLUSIONS: TNF antagonists were not associated with a risk of HF hospital admissions compared with nbDMARDs in this RA population.
Daniel H Solomon; Jeremy A Rassen; Bindee Kuriya; Lang Chen; Leslie R Harrold; David J Graham; James D Lewis; Joyce Lii; Liyan Liu; Marie R Griffin; J R Curtis
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.     Date:  2012-11-15
Journal Detail:
Title:  Annals of the rheumatic diseases     Volume:  72     ISSN:  1468-2060     ISO Abbreviation:  Ann. Rheum. Dis.     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-10-04     Completed Date:  2013-11-26     Revised Date:  2014-05-12    
Medline Journal Info:
Nlm Unique ID:  0372355     Medline TA:  Ann Rheum Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  1813-8     Citation Subset:  IM    
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MeSH Terms
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Antirheumatic Agents / adverse effects*
Arthritis, Rheumatoid / drug therapy*
Cohort Studies
Cyclooxygenase 2 Inhibitors / therapeutic use
Databases, Factual
Glucocorticoids / therapeutic use
Heart Failure / chemically induced*,  epidemiology
Hospitalization / statistics & numerical data
Middle Aged
Proportional Hazards Models
Retrospective Studies
Risk Factors
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Grant Support
1U18 HS 17919/HS/AHRQ HHS
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 0/Antirheumatic Agents; 0/Cyclooxygenase 2 Inhibitors; 0/Glucocorticoids; 0/Tumor Necrosis Factor-alpha

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

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