title: Longer durations of antitumour necrosis factor treatment are associated with reduced risk of cardiovascular events in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To assess the effects of treatment with antitumour necrosis factor (TNF) agents, methotrexate, or other non-biological disease-modifying antirheumatic drugs (DMARDs) on cardiovascular event risks among patients with rheumatoid arthritis (RA).
  
  
  METHODS
  We conducted a retrospective study using data from the MarketScan claims database. Patients with RA with ≥1 prescription for an index drug were included. Each patient's use of an index drug was calculated cumulatively as a time-varying exposure. The incidence of cardiovascular events among patients with RA was determined. Associations between drug exposures and occurrence of cardiovascular events were assessed with Cox proportional hazards models.
  
  
  RESULTS
  Of 113 677 patients identified, 35.8%, 41.1% and 23.1% received anti-TNF agents, methotrexate and other DMARDs, respectively. Patients were treated for an average of 7.6 months; 2138 patients (1.9%) had a cardiovascular event following their index prescription. Each additional 6 months of anti-TNF therapy use versus non-use reduced the risk (HR; 95% CI) for any cardiovascular event by 12% (0.88; 0.81 to 0.95, p=0.002). Anti-TNF therapy was associated with a 13% and 12% reduction in cardiovascular events in patients aged ≥50 years (0.87; 0.80 to 0.95, p=0.002) and in those without prior methotrexate use (0.88; 0.78 to 0.99, p=0.04), respectively. Cumulative use of 1, 2 or 3 years of anti-TNF therapy versus non-use is expected to reduce cardiovascular event risks by 21%, 38% and 51%, respectively.
  
  
  CONCLUSIONS
  Anti-TNF therapy was associated with a significantly lower risk of cardiovascular events among patients with RA, older patients with RA and patients without prior exposure to methotrexate.
authors.affiliation: Departments of Internal Medicine and Rheumatology , VU University Medical Centre , Amsterdam , The Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Nurmohamed
authors.affiliation: Health Economics and Outcomes Research, AbbVie , North Chicago, Illinois , USA.
authors.forename: Yanjun
authors.initials: Y
authors.lastname: Bao
authors.affiliation: The Analysis Group , Boston, Massachusetts , USA.
authors.forename: James
authors.initials: J
authors.lastname: Signorovitch
authors.affiliation: The Analysis Group , Boston, Massachusetts , USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Trahey
authors.affiliation: Health Economics and Outcomes Research, AbbVie , North Chicago, Illinois , USA.
authors.forename: Parvez
authors.initials: P
authors.lastname: Mulani
authors.affiliation: University of California-Los Angeles (UCLA) , Los Angeles, California , USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Furst
keywords: Anti-TNF; Cardiovascular Disease; Rheumatoid Arthritis