title: Tumor necrosis factor-α inhibitor treatment and the risk of incident cardiovascular events in patients with early rheumatoid arthritis: a nested case-control study.
abstract: OBJECTIVE
  To compare the risk of cardiovascular (CV) events between use of tumor necrosis factor-α inhibitors (TNFi) and nonbiologic disease-modifying antirheumatic drugs (DMARD) in patients with early rheumatoid arthritis (RA).
  
  
  METHODS
  A nested case-control study was conducted using data from Truven's MarketScan commercial and Medicare claims database for patients with early RA who started treatment with either a TNFi or a nonbiologic DMARD between January 1, 2008, and December 31, 2010. Date of CV event diagnosis for cases was defined as the event date, and 12 age-matched and sex-matched controls were sampled using incidence density sampling. Drug exposure was defined into the following mutually exclusive categories hierarchically: (1) current use of TNFi (with or without nonbiologics), (2) past use of TNFi (with or without nonbiologics), (3) current use of nonbiologics only, and (4) past use of nonbiologics only. Current use was defined as any use in the period 90 days prior to the event date. Conditional logistic regression models were used to derive incidence rate ratios (IRR).
  
  
  RESULTS
  From the cohort of patients with early RA, 279 cases of incident CV events and 3348 matched controls were identified. The adjusted risk of CV events was not significantly different between current TNFi users and current nonbiologic users (IRR 0.92, 95% CI 0.59-1.44). However, past users of nonbiologics showed significantly higher risk compared to current nonbiologic users (IRR 1.47, 95% CI 1.04-2.08).
  
  
  CONCLUSIONS
  No differences in the CV risk were found between current TNFi and current nonbiologic DMARD treatment in patients with early RA.
authors.affiliation: From the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina; Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA.R.J. Desai, PhD, Graduate Student, Research Fellow, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, and Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School, Brigham and Women's Hospital; J.K. Rao, MD, Associate Professor; G. Fang, PhD, Assistant Professor; J.F. Farley, PhD, Associate Professor, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina; R.A. Hansen, PhD, Professor, Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University; M. Maciejewski, PhD, Associate Professor, Department of Medicine, Division of General Internal Medicine Durham, Duke University.
authors.forename: Rishi J
authors.initials: RJ
authors.lastname: Desai
authors.affiliation: From the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina; Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA.R.J. Desai, PhD, Graduate Student, Research Fellow, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, and Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School, Brigham and Women's Hospital; J.K. Rao, MD, Associate Professor; G. Fang, PhD, Assistant Professor; J.F. Farley, PhD, Associate Professor, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina; R.A. Hansen, PhD, Professor, Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University; M. Maciejewski, PhD, Associate Professor, Department of Medicine, Division of General Internal Medicine Durham, Duke University.
authors.forename: Jaya K
authors.initials: JK
authors.lastname: Rao
authors.affiliation: From the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina; Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA.R.J. Desai, PhD, Graduate Student, Research Fellow, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, and Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School, Brigham and Women's Hospital; J.K. Rao, MD, Associate Professor; G. Fang, PhD, Assistant Professor; J.F. Farley, PhD, Associate Professor, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina; R.A. Hansen, PhD, Professor, Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University; M. Maciejewski, PhD, Associate Professor, Department of Medicine, Division of General Internal Medicine Durham, Duke University.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hansen
authors.affiliation: From the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina; Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA.R.J. Desai, PhD, Graduate Student, Research Fellow, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, and Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School, Brigham and Women's Hospital; J.K. Rao, MD, Associate Professor; G. Fang, PhD, Assistant Professor; J.F. Farley, PhD, Associate Professor, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina; R.A. Hansen, PhD, Professor, Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University; M. Maciejewski, PhD, Associate Professor, Department of Medicine, Division of General Internal Medicine Durham, Duke University.
authors.forename: Gang
authors.initials: G
authors.lastname: Fang
authors.affiliation: From the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina; Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA.R.J. Desai, PhD, Graduate Student, Research Fellow, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, and Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School, Brigham and Women's Hospital; J.K. Rao, MD, Associate Professor; G. Fang, PhD, Assistant Professor; J.F. Farley, PhD, Associate Professor, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina; R.A. Hansen, PhD, Professor, Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University; M. Maciejewski, PhD, Associate Professor, Department of Medicine, Division of General Internal Medicine Durham, Duke University.
authors.forename: Matthew
authors.initials: M
authors.lastname: Maciejewski
authors.affiliation: From the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina; Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA.R.J. Desai, PhD, Graduate Student, Research Fellow, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, and Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School, Brigham and Women's Hospital; J.K. Rao, MD, Associate Professor; G. Fang, PhD, Assistant Professor; J.F. Farley, PhD, Associate Professor, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina; R.A. Hansen, PhD, Professor, Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University; M. Maciejewski, PhD, Associate Professor, Department of Medicine, Division of General Internal Medicine Durham, Duke University. jffarley@email.unc.edu.
authors.forename: Joel
authors.initials: J
authors.lastname: Farley
mesh_terms: D000328:Adult; D017677:Age Distribution; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: CARDIOVASCULAR DISEASES; EARLY RHEUMATOID ARTHRITIS; NESTED CASE-CONTROL STUDY; TNF-α INHIBITORS