Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Anti Tumour Necrosis Factor Therapy Is Associated with Reduced Mortality From Ruptured Abdominal Aortic Aneurysm: Results From the British Society for Rheumatology Biologics Register.
Low1, Audrey SL, Galloway1, James B., Mercer1, Louise K., Davies1, Rebecca, Lunt1, Mark, Watson1, Kath D., British Society for Rheumatology Biologics Register (BSRBR) control centre consortium,
People with RA are at increased risk of mortality from atherosclerotic cardiovascular events such as myocardial infarction and cerebrovascular disease. Less is known about peripheral vascular disease in RA; in particular abdominal aortic aneurysm (AAA) rupture. The aim of this analysis was to explore the influence of anti-TNF therapy on the mortality from AAA rupture.
People with RA who had recently started anti-TNF therapy were recruited by the BSRBR from 20002008. Alongside this cohort, a biologic-naive comparator group treated with non-biologic disease modifying agents (nbDMARD) was also recruited. Patients were followed up by physician and patient questionnaires and flagged with the national death register. All patients were followed until 07/31/2010 or death, whichever came first. Mortality from AAA was identified from International Classification of Diseases 10 (ICD-10) codes I71.3 or I71.4 on the death certificate. The standardised mortality ratio (SMR) with 95% confidence intervals (CI) was calculated for AAA for both anti-TNF and nbDMARD cohorts with reference to the general population. Cox regression models were used to compare mortality rates of AAA between the anti-TNF and nbDMARD cohorts, with adjustment made using an inverse probability of treatment weighting (IPTW) model. Hazard ratios (HR) were calculated.
12051 patients treated with anti-TNF and 3767 patients treated with nbDMARD contributed to this analysis, with 63807 and 14892 person-years of follow-up respectively. 9 deaths from ruptured AAA were identified (3 in anti-TNF cohort; 6 in nbDMARD cohort), of which 2 were peri-operative (1 per cohort). There was a trend towards increased mortality from ruptured AAA in the nbDMARD cohort compared to the general population: SMR 2.7 (1.05.9) but this effect was not observed in the anti-TNF cohort: SMR 0.6 (0.11.7). After adjustment, patients ever exposed to anti-TNF were less likely to have died from a ruptured AAA compared to patients in the nbDMARD cohort: HR 0.08 (0.010.39).
This is further evidence supporting a biological link between TNF and atherosclerosis. Differences in the SMR could be explained by other factors e.g. hypertension and smoking. Strengths of this study include the size of the cohort and the completeness of death and cause of death ascertainment. Limitations include the low number of outcomes of interest which precluded examining for an influence of response to therapy or an effect of treatment duration.
To cite this abstract, please use the following information:
Low, Audrey SL, Galloway, James B., Mercer, Louise K., Davies, Rebecca, Lunt, Mark, Watson, Kath D., et al; Anti Tumour Necrosis Factor Therapy Is Associated with Reduced Mortality From Ruptured Abdominal Aortic Aneurysm: Results From the British Society for Rheumatology Biologics Register. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :426