Dr. Neovius has received honoraria for Advisory Board service from Pfizer (less than $10,000).
Mortality rates in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors: Drug-specific comparisons in the Swedish Biologics Register
Article first published online: 27 OCT 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 64, Issue 11, pages 3502–3510, November 2012
How to Cite
Simard, J. F., Neovius, M., Askling, J. and for the ARTIS Study Group (2012), Mortality rates in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors: Drug-specific comparisons in the Swedish Biologics Register. Arthritis & Rheumatism, 64: 3502–3510. doi: 10.1002/art.34582
- Issue published online: 27 OCT 2012
- Article first published online: 27 OCT 2012
- Accepted manuscript online: 8 AUG 2012 12:01PM EST
- Manuscript Accepted: 5 JUN 2012
- Manuscript Received: 1 OCT 2011
- Swedish Foundation for Strategic Research and Combine
- Swedish national public-private research consortium
- Strategic Research Program in Epidemiology at Karolinska Institutet
To determine whether the differences in the modes of action and safety profiles of individual tumor necrosis factor inhibitors (TNFi) translate into differential mortality risks, as investigated in etanercept, infliximab, and adalimumab.
Data on patients with rheumatoid arthritis (RA) identified in the Swedish Biologics Register (Anti-Rheumatic Therapy in Sweden [ARTIS]) in whom first-ever treatment with a biologic agent (etanercept [n = 2,686], infliximab [n = 2,027], or adalimumab [n = 1,609]) was initiated between 2003 and 2008 were linked to national Swedish registers to get information on deaths from any cause, demographic features, RA characteristics, comorbid conditions, and concurrent treatment at the start of TNFi treatment. Hazard ratios (HRs) were modeled using multivariable adjusted and weighted Cox models.
During 19,118 person-years of followup, 211 patients died (3.3%; 1.1 deaths per 100 person-years); 85% of the deaths occurred among patients who had been exposed to only one TNFi. We found no statistically significant difference in overall mortality rates across the exposure groups, regardless of adjustment and modeling approach (for infliximab versus etanercept, HR 1.1 [95% confidence interval (95% CI) 0.7–1.7], and for adalimumab versus etanercept, HR 1.3 [95% CI 0.9–2.0]).
Overall, we noted no statistically significant difference in mortality rates between the 3 TNF inhibitors under study. Further studies need to examine whether certain subsets of patients are at increased risk of death with specific TNFi.