比较托珠单抗和依那西普治疗类风湿关节炎患者心血管事件住院风险。
Comparison of the risks of hospitalisation for cardiovascular events in patients with rheumatoid arthritis treated with tocilizumab and etanercept.
机构信息
Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Italy.
Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
出版信息
Clin Exp Rheumatol. 2018 Mar-Apr;36(2):310-313. Epub 2017 Dec 28.
OBJECTIVES
To verify if tocilizumab (TCZ) is associated with an increased risk of cardiovascular (CV) events compared with etanercept (ETN) in rheumatoid arthritis (RA).
METHODS
This is a retrospective cohort study on administrative healthcare databases (AHD) in Italy. Patients were identified using a validated algorithm based on AHD. Exposure to specific drugs was estimated by the drug prescription recorded in the AHD. The occurrence of acute CV events (myocardial infarction, stroke, other CV events) was derived from the hospital discharge forms. The association between TCZ or ETN and CV events was estimated using competing risk models, adjusting for pre-specified confounders.
RESULTS
We identified 1,752 subjects with RA, 1,086 treated with ETN and 666 with TCZ. TCZ did not increase the overall risk of acute CV events, even when adjusted for pre-specified confounders (hazard ratio HR 0.95, 95% confidence interval 95%CI 0.54-1.66), specifically of acute myocardial infarction (HR 0.39, 95%CI 0.15-1.06), stroke (HR 1.44, 95%CI 0.24-8.68) or other CV event (1.07, 95%CI 0.59-1.92).
CONCLUSIONS
RA patients with TCZ do not have a medium-term excess of CV risk in patients compared with ETN.
目的
验证托珠单抗（TCZ）与依那西普（ETN）相比，在类风湿关节炎（RA）患者中是否会增加心血管（CV）事件的风险。
方法
这是一项在意大利行政医疗保健数据库（AHD）中进行的回顾性队列研究。使用基于 AHD 的验证算法识别患者。通过 AHD 中记录的药物处方估计特定药物的暴露情况。急性 CV 事件（心肌梗死、中风、其他 CV 事件）的发生源自医院出院表格。使用竞争风险模型估计 TCZ 或 ETN 与 CV 事件之间的关联，并针对预先指定的混杂因素进行调整。
结果
我们确定了 1752 名 RA 患者，其中 1086 名接受 ETN 治疗，666 名接受 TCZ 治疗。即使在调整了预先指定的混杂因素后，TCZ 也没有增加急性 CV 事件的总体风险（风险比 HR 0.95，95%置信区间 95%CI 0.54-1.66），特别是急性心肌梗死（HR 0.39，95%CI 0.15-1.06）、中风（HR 1.44，95%CI 0.24-8.68）或其他 CV 事件（1.07，95%CI 0.59-1.92）。
结论
与 ETN 相比，RA 患者接受 TCZ 治疗不会在中期增加 CV 风险。
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