Carmona Loreto, Descalzo Miguel Angel, Perez-Pampin Eva, Ruiz-Montesinos Dolores, Erra Alba, Cobo Tatiana, Gómez-Reino Juan J
Research Unit, Spanish Foundation of Rheumatology, Madrid, Spain.
Ann Rheum Dis. 2007 Jul;66(7):880-5. doi: 10.1136/ard.2006.067660. Epub 2007 Feb 26.
Mortality is increased in rheumatoid arthritis (RA), mainly because of cardiovascular (CV) events, cancer and infections. Recent data suggest that treatment with tumour necrosis factor (TNF) antagonists may affect this trend.
To assess whether treatment with TNF antagonists is associated with reduction in CV events, cancer and infection rates, and in mortality in patients with RA treated and not treated with TNF antagonists.
BIOBADASER is a registry for active long-term follow-up of safety of biological treatments in patients with RA. It includes 4459 patients with RA treated with TNF antagonists. EMECAR is an external RA cohort (n = 789) established to define the characteristics of the disease in Spain and to assess comorbidity. The incidence density (ischaemic heart disease) of CV events, cancer and infections was estimated and compared. The standardised mortality ratio was compared with the rate in the general population. A propensity score was used to match cohorts by the probability of being treated.
Rates of CV and cancer events are significantly higher in EMECAR than in BIOBADASER (RR 5-7 for different CV events, and RR 2.9 for cancer), whereas the rate of serious infections is significantly higher in BIOBADASER (RR 1.6). Mortality ratio of BIOBADASER by EMECAR is 0.32 (0.20-0.53) for all causes of death, 0.58 (0.24-1.41) for CV events, 0.52 (0.21-1.29) for infection and 0.36 (0.10-1.30) for cancer-related deaths.
Morbidity, other than infection, and mortality are not higher than expected in patients with RA treated with TNF antagonists.
类风湿关节炎（RA）患者的死亡率增加，主要原因是心血管（CV）事件、癌症和感染。近期数据表明，使用肿瘤坏死因子（TNF）拮抗剂进行治疗可能会影响这一趋势。
评估使用TNF拮抗剂治疗是否与RA患者（无论是否接受TNF拮抗剂治疗）的CV事件、癌症和感染率降低以及死亡率降低相关。
BIOBADASER是一个对RA患者生物治疗安全性进行长期主动随访的登记系统。它纳入了4459例接受TNF拮抗剂治疗的RA患者。EMECAR是一个外部RA队列（n = 789），其建立目的是确定西班牙该疾病的特征并评估合并症。对CV事件、癌症和感染的发病密度（缺血性心脏病）进行了估计和比较。将标准化死亡率与普通人群的死亡率进行了比较。使用倾向评分通过治疗概率对队列进行匹配。
EMECAR中CV和癌症事件的发生率显著高于BIOBADASER（不同CV事件的相对风险为5 - 7，癌症的相对风险为2.9），而BIOBADASER中严重感染的发生率显著更高（相对风险为1.6）。BIOBADASER相对于EMECAR的全因死亡率为0.32（0.20 - 0.53），CV事件为0.58（0.24 - 1.41），感染为0.52（0.21 - 1.29），癌症相关死亡为方法：BIOBADASER是一个对RA患者生物治疗安全性进行长期主动随访的登记系统。它纳入了4459例接受TNF拮抗剂治疗的RA患者。EMECAR是一个外部RA队列（n = 789），其建立目的是确定西班牙该疾病的特征并评估合并症。对CV事件、癌症和感染的发病密度（缺血性心脏病）进行了估计和比较。将标准化死亡率与普通人群的死亡率进行了比较。使用倾向评分通过治疗概率对队列进行匹配。
EMECAR中CV和癌症事件的发生率显著高于BIOBADASER（不同CV事件的相对风险为5 - 7，癌症的相对风险为2.9），而BIOBADASER中严重感染的发生率显著更高（相对风险为1.6）。BIOBADASER相对于EMECAR的全因死亡率为0.32（0.20 - 0.53），CV事件为0.58（0.24 - 1.41），感染为0.52（0.21 - 1.29），癌症相关死亡为0.36（0.10 - 1.30）。
除感染外，接受TNF拮抗剂治疗的RA患者的发病率和死亡率并不高于预期。 0.36（0.10 - 1.30）。
除感染外，接受TNF拮抗剂治疗的RA患者的发病率和死亡率并不高于预期。
