RESEARCH - Treatment with TNF-blockers and mortality risk in patients with RA

December 11, 2006

Ann Rheum Dis. Published Online First: 11 December 2006.

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Extended Report

Treatment with TNF-blockers and mortality risk in patients with rheumatoid

arthritis

Lennart TH sson 1*, Carl Turesson 1, Jan-Åke Nilsson 1, Ingemar

sson 2, bet Lindqvist 1, Tore Saxne 1 and Pierre Geborek 1

1 Lund University, Sweden

2 Spenshult's Hospital, Sweden

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

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.

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