Abstract

Objective: To assess mortality in patients with rheumatoid arthritis (RA) treated with TNF inhibitors, compared to a standard RA population.

Methods: Patients were recruited from a regional register, which includes over 90 % of patients with RA started on TNF blockers in the area in 1999 or later, and a local community based cohort of RA patients, established in 1997. Of a total of 1430 patients in the combined cohort under 80 yrs old, 921 received treatment with TNF inhibitors during the study period. The total cohort was linked with the national register for cause of death. Overall mortality in those treated vs. not treated with TNF blockers was estimated, using Standardised Mortality Ratios (SMRs) and time dependent Cox proportional hazards.

Results: There were 188 deaths per 7077 person- years at risk in the total cohort. Controlling for age, sex, disability and baseline co-morbidity, the adjusted hazard ratio (HR) for death was 0.65 (95 % CI: 0.46 - 0.93) in anti-TNF treated vs. not treated. The effect was statistically significant in women (HR = 0.52, 95 % CI: 0.33 - 0.82) but not in men (HR = 0.95, 95 % CI: 0.52 – 1.71).

Conclusion: Adjusting for disease severity, treatment with TNF inhibitors was associated with a reduced mortality in women but not men with RA. These findings are compatible with a critical role for inflammation in RA associated premature mortality.