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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

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


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
Author: Delcoigne, Benedicte
Ljung, Lotta
Provan, Sella A
Glintborg, Bente
Hetland, Merete Lund   orcid.org/0000-0003-4229-6818
Grøn, Kathrine Lederballe
Peltomaa, Ritva
Relas, Heikki
Turesson, Carl
Guðbjörnsson, Björn
... 2 more authors Show all authors
Date: 2022-06
Language: English
Scope: 9
University/Institute: Landspitali - The National University Hospital of Iceland
Department: Faculty of Medicine
Internal Medicine and Emergency Services
Series: Annals of the Rheumatic Diseases; 81(6)
ISSN: 0003-4967
DOI: https://doi.org/10.1136/annrheumdis-2021-221996
Subject: Gigtarlæknisfræði; Iktsýki; Kransæðasjúkdómar; Líftæknilyf; biological therapy; cardiovascular diseases; rheumatoid arthritis; tumor necrosis factor inhibitors
URI: https://hdl.handle.net/20.500.11815/3185

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Citation:

Delcoigne , B , Ljung , L , Provan , S A , Glintborg , B , Hetland , M L , Grøn , K L , Peltomaa , R , Relas , H , Turesson , C , Guðbjörnsson , B , Michelsen , B & Askling , J 2022 , ' 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 ' , Annals of the Rheumatic Diseases , vol. 81 , no. 6 , pp. 789-797 . https://doi.org/10.1136/annrheumdis-2021-221996

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 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.

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© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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