Tumour necrosis factor antagonist use and associated risk reduction of cardiovascular events among patients with rheumatoid arthritis

• Published in: Annals of the rheumatic diseases Vol. 70; no. 4; pp. 576 - 582
• Main Authors: Greenberg, Jeffrey D, Kremer, Joel M, Curtis, Jeffrey R, Hochberg, Marc C, Reed, George, Tsao, Peter, Farkouh, Michael E, Nasir, Adeel, Setoguchi, Soko, Solomon, Daniel H
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.04.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - epidemiology; Biological and medical sciences; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Diseases of the osteoarticular system; Epidemiologic Methods; Female; Health risk assessment; Heart attacks; Humans; Immunologic Factors - therapeutic use; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Studies; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF; United States - epidemiology; United States; Human; Immunopathology; Chronic; Tumor necrosis factor; Rheumatoid arthritis; Diseases of the osteoarticular system; Risk factor; Rheumatology; Autoimmune disease; Inflammatory joint disease; Antagonist
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2010.129916

Objective To examine the association of cardiovascular events with tumour necrosis factor (TNF) α antagonist use compared with non-biological disease-modifying antirheumatic drug (DMARD) utilisation in patients with rheumatoid arthritis (RA). Methods The study population included 10 156 patients enrolled in the Consortium of Rheumatology Researchers of North America RA registry. Three study cohorts were defined based on three mutually exclusive drug use categories, including TNF antagonists, methotrexate and other non-biological DMARDs. HR were calculated adjusting for cardiovascular risk factors, RA disease characteristics and prednisone use. The primary study outcome was a composite of non-fatal myocardial infarction (MI), transient ischaemic attack (TIA) or stroke and cardiovascular-related death. Results There were 88 cardiovascular events, including 26 MI, 45 TIA/strokes and 17 cardiovascular-related deaths. After adjusting for age, gender, cardiovascular risk factors and RA disease characteristics, patients using a TNF antagonist experienced a reduced risk of the primary composite cardiovascular endpoint (HR 0.39, 95% CI 0.19 to 0.82) compared with users of non-biological DMARDs. Methotrexate was not associated with a reduced risk (HR 0.94, 95% CI 0.49 to 1.80). Prednisone use was associated with a dose-dependent increased risk (p=0.04). The risk reduction associated with TNF antagonists was also observed for non-fatal cardiovascular events (HR 0.35, 95% CI 0.16 to 0.74). Conclusion TNF antagonist use was associated with a reduced risk of cardiovascular events in patients with RA.