No increased mortality in patients with rheumatoid arthritis treated with biologics: results from the biologics register of six rheumatology institutes in Japan.
OBJECTIVE
To investigate the influence of biologics on mortality and risk factors for death in rheumatoid arthritis (RA) patients.


METHODS
RA patients treated with at least one dose of biologics in daily practice in six large rheumatology institutes ("biologics cohort") were observed until 15 May 2010 or death, whichever occurred first. Mortality of the biologics cohort and the "comparator cohort" (comprising patients among the IORRA cohort who had never been treated with biologics) was compared to that of the Japanese general population. Factors associated with mortality were assessed by a Cox model.


RESULTS
Among 2683 patients with 6913.0 patient-years of observation, 38 deaths were identified in the biologics cohort. The probability of death in patients lost to follow-up, calculated using the weighted standardized mortality ratio (SMR), was 1.08 [95 % confidence interval (CI) 0.77-1.47] in the biologics cohort and 1.28 (95 % CI 1.17-1.41) in the comparator cohort. Pulmonary involvement was the main cause of death (47.4 %), and the disease-specific SMR of pneumonia was 4.19 (95 % CI 1.81-8.25). Risk factors for death included male gender [hazard ratio (HR) 2.78 (95 % CI 1.24-6.22)], advanced age (HR 1.07, 95 % CI 1.03-1.11), and corticosteroid dose (HR 1.08, 95 % CI 1.01-1.17).


CONCLUSIONS
Mortality in RA patients exposed to biologics did not exceed that in patients not exposed to biologics, but death from pulmonary manifestations was proportionally increased in RA patients exposed to biologics.
Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-054, Japan, ayakonkj@ior.twmu.ac.jp.
Ayako
A
Nakajima
Kazuyoshi
K
Saito
Toshihisa
T
Kojima
Koichi
K
Amano
Taku
T
Yoshio
Wataru
W
Fukuda
Eisuke
E
Inoue
Atsuo
A
Taniguchi
Shigeki
S
Momohara
Seiji
S
Minota
Tsutomu
T
Takeuchi
Naoki
N
Ishiguro
Yoshiya
Y
Tanaka
Hisashi
H
Yamanaka
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000401:mortality; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors
D018501:Antirheumatic Agents; D001688:Biological Products