Rodriguez-Rodriguez Luis, Leon Leticia, Ivorra-Cortes Jose, Gómez Alejandro, Lamas Jose Ramon, Pato Esperanza, Jover Juan Ángel, Abásolo Lydia
Department of Rheumatology and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Madrid, Spain.
Department of Rheumatology and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Madrid; and Universidad Camilo José Cela, Madrid, Spain.
Clin Exp Rheumatol. 2016 Nov-Dec;34(6):1026-1032. Epub 2016 Oct 7.
To assess the mortality rate (MR) and the mortality risk of a rheumatoid arthritis (RA) inception cohort, with and without biologic agents (BAs). Other factors associated to mortality were also investigated.
Retrospective longitudinal study of RA patients, attending the rheumatology outpatient clinic of a tertiary Hospital (Madrid), collected over 5 years (2000-2004), and followed from the diagnosis of RA up to the patients' death, lost to follow-up or September 2013. The dependent variable was death and the independent variable was exposure to BAs. Covariables: sociodemographic, clinical and therapy variables. MR was expressed per 1,000 patient-years with the 95% confidence interval [CI]. BA influence on MR was analysed by multivariable Cox models. Clinical and therapy variables were used in a time-dependent manner. The results are expressed in hazard ratio (HR) and [CI].
We included 576 patients and 711 courses of therapy. 19.6% were taking BA, 86% disease-modifying anti-rheumatic drugs (DMARDs) (70% on methotrexate - MTX), and 12% were untreated. There were 133 deaths during 4,981.64 patient-years at risk. The MR for BA was 12.6 [6-26], for DMARDs was 22.3 [18.4-27.1], and for those without treatment was 89.1 [61.9-128.2]. The adjusted HR for mortality in those exposed to BA versus those not exposed was 0.75 [0.32-1.71]). Other variables independently associated with mortality were: age, rheumatoid factor, hospital admissions, Health Assessment Questionnaire (HAQ), and MTX use (HR: 0.44 [0.29-0.66]).
BAs and standard DMARDs are more effective in decreasing mortality compared to no therapy. Patients exposed to Bas were not associated with a significant increase or decrease in mortality when compared to patients with non-biological DMARDs. The use of MTX remains the only drug that has independently shown a beneficial effect on mortality.
评估类风湿关节炎（RA）起始队列在使用和未使用生物制剂（BA）情况下的死亡率（MR）及死亡风险。还对与死亡相关的其他因素进行了调查。
对一家三级医院（马德里）风湿科门诊在5年（2000 - 2004年）期间收集的RA患者进行回顾性纵向研究，从RA诊断开始随访直至患者死亡、失访或2013年9月。因变量为死亡，自变量为是否接触BA。协变量：社会人口统计学、临床和治疗变量。MR以每1000患者年表示，并给出95%置信区间[CI]。通过多变量Cox模型分析BA对MR的影响。临床和治疗变量采用时间依赖性方式使用。结果以风险比（HR）和[CI]表示。
我们纳入了576例患者和711个疗程。19.6%的患者使用BA，86%使用改善病情抗风湿药物（DMARDs）（70%使用甲氨蝶呤 - MTX），12%未接受治疗。在4981.64患者年的风险期内有133例死亡。使用BA的MR为12.6[6 - 26]，使用DMARDs的为22.3[18.4 - 27.1]，未接受治疗的为89.1[61.9 - 128.2]。接触BA者与未接触者相比，调整后的死亡HR为0.75[0.32 - 1.71]）。其他与死亡独立相关的变量包括：年龄、类风湿因子、住院次数、健康评估问卷（HAQ）和MTX使用情况（HR：0.44[0.29 - 0.66]）。
与未治疗相比，BA和标准DMARDs在降低死亡率方面更有效。与使用非生物DMARDs的患者相比，接触BA的患者死亡率未显著增加或降低。MTX的使用仍然是唯一已独立显示对死亡率有有益影响的药物。
