TNF inhibitors, MTX reduce RA cardiovascular deaths

[Guest guest]

TNF inhibitors, MTX reduce RA cardiovascular deaths



Nov 25, 2005



Janis



" Despite more severe RA at onset, anti-TNF and MTX therapies appear

to convey a mortality benefit. "

San Diego, CA - TNF inhibitors and methotrexate (MTX) decrease the

risk of death, especially cardiovascular (CV) death, in rheumatoid-

arthritis (RA) patients, whereas prednisone increases mortality,

Kaleb Michaud (Stanford University, CA) reported at the 2005 ACR/ARHP

Annual Scientific Meeting [1].

According to Michaud, anti-TNF use was associated with a reduced risk

of mortality (hazard ratio

---

0.69), as was MTX (HR 0.84).

Prednisone use, however, was associated with increased mortality (HR

1.63). " Despite more severe RA at onset, anti-TNF and MTX therapies

appear to convey a mortality benefit, " said Michaud.

First study to show survival benefit

Michaud and coauthor Dr Frederick Wolfe (National Data Bank for

Rheumatic Diseases, Wichita, KS) analyzed data from a long-term

outcome study of 19 580 patients with RA. During 63 811 patient-years

of follow-up, there were 1129 deaths. The researchers used initial

Health Assessment Questionnaire (HAQ) scores to adjust for baseline

severity, time-varying HAQ scores to account for changes in severity

as the result of therapy, and a baseline comorbidity index of 13

medical conditions to adjust for baseline concomitant diseases.

" In clinical trials, anti-TNF therapy is superior to conventional

therapies for the treatment of rheumatoid arthritis. However, there

is, as yet, no evidence of long-term benefit for this treatment, and

there is concern regarding long-term toxicity. Studies of mortality

can provide a 'hard' end point that can provide evidence regarding

these issues. Such studies usually require many years of follow-up,

unless a very large sample is available. We used such a sample to

assess the effect of contemporary treatment on mortality in RA, "

Michaud said.

The analysis showed that 45% of deaths were due to cardiovascular

disorders, 29% to lung disorders, 23% to malignancies, and 8% to

infections. Prednisone was associated with increased mortality (HR

1.63). TNF inhibitors were associated with reduced mortality (HR

0.69), as was MTX (HR 0.84).

Given the importance of CV risk in this population, the effect of

treatment on risk of CV death was particularly interesting. Michaud

reported that MTX, infliximab, and etanercept were all strongly

associated with a decreased risk of CV mortality (HR 0.61-0.74),

whereas prednisone was associated with an increased risk of CV

mortality.

This raises the intriguing question of whether the improvement in CV

risk observed in patients taking TNF inhibitors or MTX was due to

treatment or reflected a lowering of CV risk attributable to less use

of prednisone.

" It is well documented that rheumatoid-arthritis patients have

[higher mortality rates than] the general population. Although these

patients and their physicians should continue to monitor and make

sound and personalized decisions about their prescribed

therapies, . . . they should note that the use of methotrexate and

anti-TNF therapy improves survival, " Michaud concluded.

http://www.jointandbone.org/viewArticle.do?primaryKey=610635