Mortality is increased in rheumatoid arthritis (RA), mainly due to cardiovascular (CV) events, cancer, and infections. Recent data suggest that treatment with TNF antagonists may impact on this trend.
Objective: To assess whether treatment with TNF antagonists is associated with reduction in CV events, cancer and infection rates, and in mortality in RA patients treated compared with not treated with TNF antagonists .
Methods: BIOBADASER is a registry for active long- term follow-up of safety of biological therapies in rheumatic patients. It includes 4,459 RA patients treated with TNF antagonists. EMECAR is an external RA cohort (n=789) established to define the characteristics of the disease in Spain and to assess comorbidity. The incidence density (IHD) of CV events, cancer, and infections was estimated and compared in both cohorts. The Standardized Mortality Ratio (SMR) was compared with rate in the general population. A propensity score was used to match cohorts by the probability of being treated.
Results: Rates of CV and cancer events are significantly higher in EMECAR than in BIOBADASER (RR= 5 to 7 for different CV events, and RR=2.9 for cancer, respectively) whereas rate of serious infections is significantly higher in BIOBADASER (RR=1.6). Mortality rate ratio of BIOBADASER by EMECAR is 0.32 (0.20 - 0.53) for all causes of death , 0.58 (0.24 - 1.41), for cardiovascular 0.52 (0.21 - 1.29), for infection and 0.36 (0.10 - 1.30) for cancer related deaths.
Conclusion: Morbidity, other than infection, and mortality are not higher than expected in patients with RA treated with TNF antagonist.
- TNF antagonists
- rheumatoid arthritis