New research confirms 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.
RA is a chronic, autoimmune disease characterized by inflammation in the joints that causes pain, tenderness and swelling. The World Health Organization estimates that RA affects up to one percent of individuals worldwide, with more than one million Americans diagnosed with the disease according to the ACR. Rheumatologists recommend early intervention with biologic disease modifying anti-rheumatic drugs (DMARDs) such as TNF inhibitors to slow disease progression, improve function, and prevent disability.
In Sweden nearly 15% of RA patients are prescribed TNF inhibitors. The present 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 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.
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