Researchers from Sweden have found no significant difference in the rates of death among patients with rheumatoid arthritis (RA) who were exposed to one of several TNF inhibitors used to treat RA—adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade). This population-based study of RA patients in Sweden—the first to compare mortality rates among patients treated with individual TNF inhibitors—is now available in Arthritis & Rheumatism, a journal published by Wiley on behalf of the American College of Rheumatology (ACR).
RA Drugs and Death Rates: New Information
1 min read Premium comments
Secondary
This study examined the mortality rates in RA patients exposed to adalimumab, etanercept, or infliximab. “Understanding risk versus benefits of treatment with the most commonly prescribed biologics is important for physicians and patients in managing RA, ” said lead author Dr. Julia Fridman Simard in the August 8, 2012 news release. Dr. Simard is with the Clinical Epidemiology Unit at Karolinska Institute in Stockholm, Sweden.
Researchers linked data from the Swedish Biologics Register (ARTIS), a comprehensive database of patients initiating first-ever biologic therapy for rheumatic diseases, and information from national Swedish registers that included data such as all-cause mortality, demographics, and RA characteristics. Between 2003 and 2008, 1, 609 patients with RA initiated treatment with adalimumab, 2, 686 with etanercept, and 2, 027 with infliximab as their first ever biologic DMARD.
There were more than 19, 000 person-years of follow-up during the five-year study period during which time 211 patients died (3.3%). “While we found no statistically significant difference in mortality rates across the three biologic therapies, further studies are needed to determine if this is true across certain subsets of patients with RA, ” concludes Dr. Simard.
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.