RESEARCH - All-cause mortality in RA

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ACR/ARHP 2008 Scientific Meeting

Presentation: 296 - All-Cause Mortality in RA

Pres. Time: Sunday, Oct 26, 2008, 9:00 AM -11:00 AM

Location: Hall A, Poster Board: 296

Category: 17. RA: clinical aspects

Author(s): Chester Wasko1, Helen Hubert2, Bharathi Lingala3,

Thaddeus Osial, Jr1, Terrence Starz1, Luggen4, Fries5.

1University of Pittsburgh, Pittsburgh, PA; 2Sr. Epidemiologist, Menlo

Park, CA; 3Stanford University School of Medicine, Palo Alto, CA;

4University of Cincinnati Medical Center, Cincinnati, OH; 5Stanford

University, Palo Alto, CA

Abstract: All-cause mortality is increased in patients with rheumatoid

arthritis (RA). While nonsteroidal anti-inflammatory drugs (NSAIDs),

corticosteroids, disease-modifying drugs (DMARDs), and anti-tumor

necrosis factor (TNF) drugs improve signs and symptoms of RA, they may

increase the risk of potentially life-threatening events and adversely

affect survival.

Aim: Examine the relationship between RA-related drugs and all-cause

mortality in an established cohort of RA patients followed

prospectively from 1981 to 2003.

Methods: Participants in ARAMIS, a prospective multicenter

longitudinal study of outcomes in RA, completed a health assessment

questionnaire (HAQ) every 6 months, reporting RA medication use,

comorbidities, and health habits. Data from study inception through

2003 (last date for death ascertainment using the National Death

Index) were analyzed; for antiTNF drugs, data were collected

1998-2003. time-varying multivariable regression models stratified

by 9 study sites that included sociodemographic risk factors and

health habits were used to test the relationship of RA drugs to death.

Results: Data from 5807 RA patients were analyzed; 1072 died. Subjects

were 56.6 y old on average at entry, predominantly female (76%) and

caucasian (88%), with mean education 12.7 y. In the initial

regressions, sociodemographic risk factors independently associated

with increased risk for death were older age, male gender, less

education, earlier year of study entry, high and low BMI (p<0.001),

white race, smoking, and diabetes (p<0.05). Results of the regression

models examining the relationship between RA drugs and mortality is

below. HAQ-DI also was significantly associated with mortality. With

the exception of hydroxychloroquine (Hazard Ratio = 0.90, p=0.29), the

associations of RA drugs to mortality did not substantially change

with the addition of HAQ-DI to the models.

Conclusions: Of RA drugs, prednisone is associated with dramatic

increase in risk of death, whereas hydroxychloroquine, methotrexate

and nonMTX nonHCQ DMARDs reduce risk. A similar trend is seen with

aspirin and nonaspirin NSAIDs. In spite of their dramatic clinical

efficacy in treating RA, anti-TNF agents appear to have no effect on

5-year mortality risk. Further work is in progress to address

propensity for drug therapies as possible explanations for these

findings.

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Presentation 296

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