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Response to biological treatment and subsequent risk of coronary events in rheumatoid arthritis

Ljung, Lotta; Rantapää-Dahlqvist, Solbritt; Jacobsson, Lennart T H LU ; Askling, Johan; Klareskog, Lars; van Vollenhoven, Ronald; Baecklund, Eva; Kastbom, Alf; Jacobsson, Lennart LU and Turesson, Carl LU , et al. (2016) In Annals of the Rheumatic Diseases
Abstract

Objectives Whether the increased risk of comorbidities, such as cardiovascular disease, in rheumatoid arthritis (RA) can be reverted by particular antirheumatic therapies, or response to these, is unclear but of critical clinical importance. We wanted to investigate whether response to tumour necrosis factor inhibitors (TNFi) translates into a reduced risk for acute coronary syndrome (ACS). Methods A cohort of patients with RA initiating a first TNFi 2001-2012 was identified in the Swedish Biologics Register. The association between European League Against Rheumatism (EULAR) response after 3-8 months of treatment (assessed using the first, the best and the measurement closest to 5 months, respectively), and the risk of incident ACS... (More)

Objectives Whether the increased risk of comorbidities, such as cardiovascular disease, in rheumatoid arthritis (RA) can be reverted by particular antirheumatic therapies, or response to these, is unclear but of critical clinical importance. We wanted to investigate whether response to tumour necrosis factor inhibitors (TNFi) translates into a reduced risk for acute coronary syndrome (ACS). Methods A cohort of patients with RA initiating a first TNFi 2001-2012 was identified in the Swedish Biologics Register. The association between European League Against Rheumatism (EULAR) response after 3-8 months of treatment (assessed using the first, the best and the measurement closest to 5 months, respectively), and the risk of incident ACS during the subsequent year was analysed in Cox regression models. Adjustments included cardiovascular risk factors, joint surgery, RA duration, education and work disability. Results During 6592 person-years among TNFi initiators (n=6864, mean age 55 years, 77% women), 47 ACS occurred. The adjusted HRs (95% CI), which were similar to the crude HRs, of the 1-year risk of ACS among EULAR good responders compared with nonresponders were 0.5 (0.2 to 1.4), 0.4 (0.2 to 0.9) and 0.5 (0.2 to 1.2), for the first, the best and the evaluation closest to 5 months, respectively. EULAR moderate responders had equal risk to that of EULAR non-responders, who, compared with the general population referents (n=34 229), had a more than twice the risk of ACS. For good responders, there was no statistically significant difference in risk versus the general population. Conclusions Optimised RA disease control has the potential to revert otherwise increased risks for ACS in RA.

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Annals of the Rheumatic Diseases
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British Medical Association
external identifiers
  • Scopus:84962300219
ISSN
0003-4967
DOI
10.1136/annrheumdis-2015-208995
language
English
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yes
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9332196a-e922-4cd8-8158-f154659b6871
date added to LUP
2016-06-07 12:19:50
date last changed
2016-11-14 09:42:53
@misc{9332196a-e922-4cd8-8158-f154659b6871,
  abstract     = {<p>Objectives Whether the increased risk of comorbidities, such as cardiovascular disease, in rheumatoid arthritis (RA) can be reverted by particular antirheumatic therapies, or response to these, is unclear but of critical clinical importance. We wanted to investigate whether response to tumour necrosis factor inhibitors (TNFi) translates into a reduced risk for acute coronary syndrome (ACS). Methods A cohort of patients with RA initiating a first TNFi 2001-2012 was identified in the Swedish Biologics Register. The association between European League Against Rheumatism (EULAR) response after 3-8 months of treatment (assessed using the first, the best and the measurement closest to 5 months, respectively), and the risk of incident ACS during the subsequent year was analysed in Cox regression models. Adjustments included cardiovascular risk factors, joint surgery, RA duration, education and work disability. Results During 6592 person-years among TNFi initiators (n=6864, mean age 55 years, 77% women), 47 ACS occurred. The adjusted HRs (95% CI), which were similar to the crude HRs, of the 1-year risk of ACS among EULAR good responders compared with nonresponders were 0.5 (0.2 to 1.4), 0.4 (0.2 to 0.9) and 0.5 (0.2 to 1.2), for the first, the best and the evaluation closest to 5 months, respectively. EULAR moderate responders had equal risk to that of EULAR non-responders, who, compared with the general population referents (n=34 229), had a more than twice the risk of ACS. For good responders, there was no statistically significant difference in risk versus the general population. Conclusions Optimised RA disease control has the potential to revert otherwise increased risks for ACS in RA.</p>},
  author       = {Ljung, Lotta and Rantapää-Dahlqvist, Solbritt and Jacobsson, Lennart T H and Askling, Johan and Klareskog, Lars and van Vollenhoven, Ronald and Baecklund, Eva and Kastbom, Alf and Jacobsson, Lennart and Turesson, Carl and Lindqvist, Elisabeth and Forsblad-d'Elia, Helena and Feltelius, Nils and Ernestam, Sofia},
  issn         = {0003-4967},
  language     = {eng},
  month        = {03},
  publisher    = {ARRAY(0x7eb7c98)},
  series       = {Annals of the Rheumatic Diseases},
  title        = {Response to biological treatment and subsequent risk of coronary events in rheumatoid arthritis},
  url          = {http://dx.doi.org/10.1136/annrheumdis-2015-208995},
  year         = {2016},
}