Short-term, intermediate-term and long-term risks of acute coronary syndrome in cohorts of patients with RA starting biologic DMARDs : Results from four Nordic countries
(2022) In Annals of the Rheumatic Diseases 81(6). p.789-797- Abstract
Objectives: To compare the 1-year, 2-year and 5-year incidences of acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA) starting any of the biologic disease-modifying antirheumatic drugs (bDMARDs) currently available in clinical practice and to anchor these results with a general population comparator. Methods: Observational cohort study, with patients from Denmark, Finland, Norway and Sweden starting a bDMARD during 2008-2017. Time to first ACS was identified through register linkages. We calculated the 1-year, 2-year and 5-year incidence rates (IR) (on drug and ever since treatment start) and used Cox regression (HRs) to compare ACS incidences across treatments taking ACS risk factors into account. Analyses were... (More)
Objectives: To compare the 1-year, 2-year and 5-year incidences of acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA) starting any of the biologic disease-modifying antirheumatic drugs (bDMARDs) currently available in clinical practice and to anchor these results with a general population comparator. Methods: Observational cohort study, with patients from Denmark, Finland, Norway and Sweden starting a bDMARD during 2008-2017. Time to first ACS was identified through register linkages. We calculated the 1-year, 2-year and 5-year incidence rates (IR) (on drug and ever since treatment start) and used Cox regression (HRs) to compare ACS incidences across treatments taking ACS risk factors into account. Analyses were further performed separately in subgroups defined by age, number of previous bDMARDs and history of cardiovascular disease. We also compared ACS incidences to an individually matched general population cohort. Results: 24 083 patients (75% women, mean age 56 years) contributing 40 850 treatment courses were included. During the maximum (5 years) follow-up (141 257 person-years (pyrs)), 780 ACS events occurred (crude IR 5.5 per 1000 pyrs). Overall, the incidence of ACS in RA was 80% higher than that in the general population. For all bDMARDs and follow-up definitions, HRs were close to 1 (etanercept as reference) with the exception of the 5-year risk window, where signals for abatacept, infliximab and rituximab were noted. Conclusion: The rate of ACS among patients with RA initiating bDMARDs remains elevated compared with the general population. As used in routine care, the short-term, intermediate-term and longer-term risks of ACS vary little across individual bDMARDs.
(Less)
- author
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- biological therapy, cardiovascular diseases, rheumatoid arthritis, tumor necrosis factor inhibitors
- in
- Annals of the Rheumatic Diseases
- volume
- 81
- issue
- 6
- article number
- 221996
- pages
- 789 - 797
- publisher
- BMJ Publishing Group
- external identifiers
-
- scopus:85127536600
- pmid:35318218
- ISSN
- 0003-4967
- DOI
- 10.1136/annrheumdis-2021-221996
- language
- English
- LU publication?
- no
- id
- b1d848f2-b17c-435e-93c1-584809a80ca4
- date added to LUP
- 2022-06-07 13:37:56
- date last changed
- 2024-06-13 09:37:57
@article{b1d848f2-b17c-435e-93c1-584809a80ca4,
abstract = {{<p>Objectives: To compare the 1-year, 2-year and 5-year incidences of acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA) starting any of the biologic disease-modifying antirheumatic drugs (bDMARDs) currently available in clinical practice and to anchor these results with a general population comparator. Methods: Observational cohort study, with patients from Denmark, Finland, Norway and Sweden starting a bDMARD during 2008-2017. Time to first ACS was identified through register linkages. We calculated the 1-year, 2-year and 5-year incidence rates (IR) (on drug and ever since treatment start) and used Cox regression (HRs) to compare ACS incidences across treatments taking ACS risk factors into account. Analyses were further performed separately in subgroups defined by age, number of previous bDMARDs and history of cardiovascular disease. We also compared ACS incidences to an individually matched general population cohort. Results: 24 083 patients (75% women, mean age 56 years) contributing 40 850 treatment courses were included. During the maximum (5 years) follow-up (141 257 person-years (pyrs)), 780 ACS events occurred (crude IR 5.5 per 1000 pyrs). Overall, the incidence of ACS in RA was 80% higher than that in the general population. For all bDMARDs and follow-up definitions, HRs were close to 1 (etanercept as reference) with the exception of the 5-year risk window, where signals for abatacept, infliximab and rituximab were noted. Conclusion: The rate of ACS among patients with RA initiating bDMARDs remains elevated compared with the general population. As used in routine care, the short-term, intermediate-term and longer-term risks of ACS vary little across individual bDMARDs.</p>}},
author = {{Delcoigne, Benedicte and Ljung, Lotta and Provan, Sella A. and Glintborg, Bente and Hetland, Merete Lund and Grøn, Kathrine Lederballe and Peltomaa, Ritva and Relas, Heikki and Turesson, Carl and Gudbjornsson, Bjorn and Michelsen, Brigitte and Askling, Johan}},
issn = {{0003-4967}},
keywords = {{biological therapy; cardiovascular diseases; rheumatoid arthritis; tumor necrosis factor inhibitors}},
language = {{eng}},
number = {{6}},
pages = {{789--797}},
publisher = {{BMJ Publishing Group}},
series = {{Annals of the Rheumatic Diseases}},
title = {{Short-term, intermediate-term and long-term risks of acute coronary syndrome in cohorts of patients with RA starting biologic DMARDs : Results from four Nordic countries}},
url = {{http://dx.doi.org/10.1136/annrheumdis-2021-221996}},
doi = {{10.1136/annrheumdis-2021-221996}},
volume = {{81}},
year = {{2022}},
}