Association between anti-TNF-α therapy and all-cause mortality.
OBJECTIVE
To compare mortality among patients with selected autoimmune diseases treated with anti-tumor necrosis factor alpha (TNF-α) agents with similar patients treated with non-biologic therapies.


METHODS
Cohort study set within several large health care programs, 1998-2007. Autoimmune disease patients were identified using diagnoses from computerized healthcare data. Use of anti-TNF-α agents and comparison of non-biologic therapies were identified from pharmacy data, and mortality was identified from vital records and other sources. We compared new users of anti-TNF-α agents to new users of non-biologic therapies using propensity scores and Cox proportional hazards analysis to adjust for baseline differences. We also made head-to-head comparisons among anti-TNF-α agents.


RESULTS
Among the 46 424 persons included in the analysis, 2924 (6.3%) had died by the end of follow-up, including 1754 (6.1%) of the 28 941 with a dispensing of anti-TNF-α agent and 1170 (6.7%) of the 17 483 who used non-biologic treatment alone. Compared to use of non-biologic therapies, use of anti-TNF-α therapy was not associated with an increased mortality in patients with rheumatoid arthritis (adjusted hazard ratio [aHR] 0.93 with 95% confidence intervals (CI) 0.85-1.03); psoriasis, psoriatic arthritis, or ankylosing spondylitis (combined aHR 0.81 with CI 0.61-1.06; or inflammatory bowel disease (aHR 1.12 with CI 0.85-1.46). Mortality rates did not differ to an important degree between patients treated with etanercept, adalimumab, or infliximab.


CONCLUSIONS
Anti-TNF-α therapy was not associated with increased mortality among patients with autoimmune diseases.
Division of Research, Kaiser Permanente, Oakland, CA, USA. lisa.herrinton@kp.org
Lisa J
LJ
Herrinton
Liyan
L
Liu
Lang
L
Chen
Leslie R
LR
Harrold
Marsha A
MA
Raebel
Jeffrey R
JR
Curtis
Marie R
MR
Griffin
Daniel H
DH
Solomon
Kenneth G
KG
Saag
James D
JD
Lewis
D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000506:poisoning; D061067:Antibodies, Monoclonal, Humanized / Q000506:poisoning; D001327:Autoimmune Diseases / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000506:poisoning; D007223:Infant; D007231:Infant, Newborn; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept