RESEARCH - Immunosuppressive medications and hospitalization for cardiovascular events in patients with RA

[Guest guest]

Well, one nice thing about all these studies you've put up this

morning... I notice many of them are from BWH, which is where my new

rheumatologist practices. So at least it looks like I'm in a place

where they are staying on the fore-front of RA.

>

> Arthritis Rheum. 2006 Nov 29;54(12):3790-3798 [Epub ahead of print]

>

>

> Immunosuppressive medications and hospitalization for

cardiovascular events

> in patients with rheumatoid arthritis.

>

>

> DH, Avorn J, Katz JN, Weinblatt ME, Setoguchi S, Levin R,

> Schneeweiss S.

>

> Brigham and Women's Hospital, Harvard Medical School, Boston,

Massachusetts.

>

> OBJECTIVE: The risk of cardiovascular disease (CVD) is increased

in patients

> with rheumatoid arthritis (RA), most likely because of increased

systemic

> inflammation. Prior research suggests that immunosuppressive

medications may

> reduce the risk of CVD among RA patients. This study was

undertaken to

> investigate the effects of various immunosuppressive medications

on the risk

> of cardiovascular events among a group of older patients with RA.

METHODS:

> In this nested case-control study, the source cohort was derived

from

> Medicare beneficiaries receiving a drug benefit from the state of

> Pennsylvania. These individuals were required to have been

diagnosed as

> having RA on at least 2 visits and to have filled a prescription

for an

> immunosuppressive agent. Cases were defined as those patients who

were

> hospitalized for a cardiovascular event such as myocardial

infarction or

> stroke, and 10 control subjects were matched to each case by age,

sex, and

> calendar year of the index date (the time of the first

cardiovascular event

> in each case). Current use of an immunosuppressive medication was

defined as

> having filled a prescription for these agents within the 90 days

prior to

> the index date. Multivariate logistic regression models that

included

> important covariates were assessed to determine the risk of

cardiovascular

> events associated with immunosuppressive agents and their

combinations.

> RESULTS: Among the study cohort, we identified 3,501 RA patients

who

> fulfilled our eligibility criteria. During followup of this

cohort, 946

> patients were hospitalized for a cardiovascular event. Although

the 95%

> confidence intervals (95% CIs) were wide in adjusted risk

regression models

> with methotrexate (MTX) monotherapy as the reference group,

biologic

> immunosuppressive agents showed neither protective nor deleterious

effects

> (with biologics monotherapy, odds ratio [OR] 1.0, 95% CI 0.5-1.9;

with

> biologics plus MTX combination therapy, OR 0.8, 95% CI 0.3-2.0;

and with

> biologics plus other immunosuppressive agents, OR 1.2, 95% CI 0.7-

2.2).

> Monotherapy with oral glucocorticoids was associated with an

increased risk

> of cardiovascular events (OR 1.5, 95% CI 1.1 - 2.1), and a similar

trend in

> the direction of risk was seen with glucocorticoid combination

therapy (OR

> 1.3, 95% CI 0.8-2.0). Cytotoxic immunosuppressive agents other

than MTX

> (azathioprine, cyclosporine, and leflunomide) were also associated

with an

> increased risk of cardiovascular events (with both monotherapy and

> combination treatment, OR 1.8, 95% CI 1.1-3.0).

>

> CONCLUSION: When compared with RA patients receiving MTX

monotherapy, those

> receiving biologic immunosuppressive agents had neither an

increased nor

> decreased risk of experiencing a cardiovascular event, whereas use

of oral

> glucocorticoids and cytotoxic immunosuppressive agents was

associated with

> significant increases in the risk of cardiovascular events.

>

> PMID: 17136752

>

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

cmd=Retrieve & db=PubMed & list_uids=17136752

>

>

>

>

>

> Not an MD

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>

[Guest guest]

,

Trying to redeem myself, LOL.

No doubt you are going to a solid institution. Lots of good research from

them. Great reputation.

It wonder if it is the same TB test mentioned in that article that they are

examining in the study you were asked to consider. Let me know if you decide

to do it.

After reading about your first visit, I wondered whether they have a shuttle

or other services for patients who are not able to do much walking. For

example, when I went to Mayo (in MN), they had shuttles between buildings

and volunteers who could meet you with a wheelchair just about anywhere.

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] Re: RESEARCH - Immunosuppressive medications and

hospitalization for cardiovascular events in patients with RA

> Well, one nice thing about all these studies you've put up this

> morning... I notice many of them are from BWH, which is where my new

> rheumatologist practices. So at least it looks like I'm in a place

> where they are staying on the fore-front of RA.

>

>

>

>

>>

>> Arthritis Rheum. 2006 Nov 29;54(12):3790-3798 [Epub ahead of print]

>>

>>

>> Immunosuppressive medications and hospitalization for

> cardiovascular events

>> in patients with rheumatoid arthritis.

>>

>>

>> DH, Avorn J, Katz JN, Weinblatt ME, Setoguchi S, Levin R,

>> Schneeweiss S.

>>

>> Brigham and Women's Hospital, Harvard Medical School, Boston,

> Massachusetts.

>>

>> OBJECTIVE: The risk of cardiovascular disease (CVD) is increased

> in patients

>> with rheumatoid arthritis (RA), most likely because of increased

> systemic

>> inflammation. Prior research suggests that immunosuppressive

> medications may

>> reduce the risk of CVD among RA patients. This study was

> undertaken to

>> investigate the effects of various immunosuppressive medications

> on the risk

>> of cardiovascular events among a group of older patients with RA.

> METHODS:

>> In this nested case-control study, the source cohort was derived

> from

>> Medicare beneficiaries receiving a drug benefit from the state of

>> Pennsylvania. These individuals were required to have been

> diagnosed as

>> having RA on at least 2 visits and to have filled a prescription

> for an

>> immunosuppressive agent. Cases were defined as those patients who

> were

>> hospitalized for a cardiovascular event such as myocardial

> infarction or

>> stroke, and 10 control subjects were matched to each case by age,

> sex, and

>> calendar year of the index date (the time of the first

> cardiovascular event

>> in each case). Current use of an immunosuppressive medication was

> defined as

>> having filled a prescription for these agents within the 90 days

> prior to

>> the index date. Multivariate logistic regression models that

> included

>> important covariates were assessed to determine the risk of

> cardiovascular

>> events associated with immunosuppressive agents and their

> combinations.

>> RESULTS: Among the study cohort, we identified 3,501 RA patients

> who

>> fulfilled our eligibility criteria. During followup of this

> cohort, 946

>> patients were hospitalized for a cardiovascular event. Although

> the 95%

>> confidence intervals (95% CIs) were wide in adjusted risk

> regression models

>> with methotrexate (MTX) monotherapy as the reference group,

> biologic

>> immunosuppressive agents showed neither protective nor deleterious

> effects

>> (with biologics monotherapy, odds ratio [OR] 1.0, 95% CI 0.5-1.9;

> with

>> biologics plus MTX combination therapy, OR 0.8, 95% CI 0.3-2.0;

> and with

>> biologics plus other immunosuppressive agents, OR 1.2, 95% CI 0.7-

> 2.2).

>> Monotherapy with oral glucocorticoids was associated with an

> increased risk

>> of cardiovascular events (OR 1.5, 95% CI 1.1 - 2.1), and a similar

> trend in

>> the direction of risk was seen with glucocorticoid combination

> therapy (OR

>> 1.3, 95% CI 0.8-2.0). Cytotoxic immunosuppressive agents other

> than MTX

>> (azathioprine, cyclosporine, and leflunomide) were also associated

> with an

>> increased risk of cardiovascular events (with both monotherapy and

>> combination treatment, OR 1.8, 95% CI 1.1-3.0).

>>

>> CONCLUSION: When compared with RA patients receiving MTX

> monotherapy, those

>> receiving biologic immunosuppressive agents had neither an

> increased nor

>> decreased risk of experiencing a cardiovascular event, whereas use

> of oral

>> glucocorticoids and cytotoxic immunosuppressive agents was

> associated with

>> significant increases in the risk of cardiovascular events.

>>

>> PMID: 17136752

>>

>> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

> cmd=Retrieve & db=PubMed & list_uids=17136752

>>

>>

>>

>>

>>

>> Not an MD

>>

>> I'll tell you where to go!

>>

>> Mayo Clinic in Rochester

>> http://www.mayoclinic.org/rochester

>>

>> s Hopkins Medicine

>> http://www.hopkinsmedicine.org

>>

>

>

>

>

>

[Guest guest]

Arthritis Rheum. 2006 Dec;54(12):3790-8.

Immunosuppressive medications and hospitalization for cardiovascular events

in patients with rheumatoid arthritis.

Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

02120, USA. dhsolomon@...

OBJECTIVE: The risk of cardiovascular disease (CVD) is increased in patients

with rheumatoid arthritis (RA), most likely because of increased systemic

inflammation. Prior research suggests that immunosuppressive medications may

reduce the risk of CVD among RA patients. This study was undertaken to

investigate the effects of various immunosuppressive medications on the risk

of cardiovascular events among a group of older patients with RA. METHODS:

In this nested case-control study, the source cohort was derived from

Medicare beneficiaries receiving a drug benefit from the state of

Pennsylvania. These individuals were required to have been diagnosed as

having RA on at least 2 visits and to have filled a prescription for an

immunosuppressive agent. Cases were defined as those patients who were

hospitalized for a cardiovascular event such as myocardial infarction or

stroke, and 10 control subjects were matched to each case by age, sex, and

calendar year of the index date (the time of the first cardiovascular event

in each case). Current use of an immunosuppressive medication was defined as

having filled a prescription for these agents within the 90 days prior to

the index date. Multivariate logistic regression models that included

important covariates were assessed to determine the risk of cardiovascular

events associated with immunosuppressive agents and their combinations.

RESULTS: Among the study cohort, we identified 3,501 RA patients who

fulfilled our eligibility criteria. During followup of this cohort, 946

patients were hospitalized for a cardiovascular event. Although the 95%

confidence intervals (95% CIs) were wide in adjusted risk regression models

with methotrexate (MTX) monotherapy as the reference group, biologic

immunosuppressive agents showed neither protective nor deleterious effects

(with biologics monotherapy, odds ratio [OR] 1.0, 95% CI 0.5-1.9; with

biologics plus MTX combination therapy, OR 0.8, 95% CI 0.3-2.0; and with

biologics plus other immunosuppressive agents, OR 1.2, 95% CI 0.7-2.2).

Monotherapy with oral glucocorticoids was associated with an increased risk

of cardiovascular events (OR 1.5, 95% CI 1.1-2.1), and a similar trend in

the direction of risk was seen with glucocorticoid combination therapy (OR

1.3, 95% CI 0.8-2.0). Cytotoxic immunosuppressive agents other than MTX

(azathioprine, cyclosporine, and leflunomide) were also associated with an

increased risk of cardiovascular events (with both monotherapy and

combination treatment, OR 1.8, 95% CI 1.1-3.0).

CONCLUSION: When compared with RA patients receiving MTX monotherapy, those

receiving biologic immunosuppressive agents had neither an increased nor

decreased risk of experiencing a cardiovascular event, whereas use of oral

glucocorticoids and cytotoxic immunosuppressive agents was associated with

significant increases in the risk of cardiovascular events.

PMID: 17136752

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=17136752

Not an MD