title: Treatment in rheumatoid arthritis and mortality risk in clinical practice: the role of biologic agents.
abstract: OBJECTIVE
  To assess the mortality rate (MR) and the mortality risk of a rheumatoid arthritis (RA) inception cohort, with and without biologic agents (BAs). Other factors associated to mortality were also investigated.
  
  
  METHODS
  Retrospective longitudinal study of RA patients, attending the rheumatology outpatient clinic of a tertiary Hospital (Madrid), collected over 5 years (2000-2004), and followed from the diagnosis of RA up to the patients' death, lost to follow-up or September 2013. The dependent variable was death and the independent variable was exposure to BAs. Covariables: sociodemographic, clinical and therapy variables. MR was expressed per 1,000 patient-years with the 95% confidence interval [CI]. BA influence on MR was analysed by multivariable Cox models. Clinical and therapy variables were used in a time-dependent manner. The results are expressed in hazard ratio (HR) and [CI].
  
  
  RESULTS
  We included 576 patients and 711 courses of therapy. 19.6% were taking BA, 86% disease-modifying anti-rheumatic drugs (DMARDs) (70% on methotrexate - MTX), and 12% were untreated. There were 133 deaths during 4,981.64 patient-years at risk. The MR for BA was 12.6 [6-26], for DMARDs was 22.3 [18.4-27.1], and for those without treatment was 89.1 [61.9-128.2]. The adjusted HR for mortality in those exposed to BA versus those not exposed was 0.75 [0.32-1.71]). Other variables independently associated with mortality were: age, rheumatoid factor, hospital admissions, Health Assessment Questionnaire (HAQ), and MTX use (HR: 0.44 [0.29-0.66]).
  
  
  CONCLUSIONS
  BAs and standard DMARDs are more effective in decreasing mortality compared to no therapy. Patients exposed to Bas were not associated with a significant increase or decrease in mortality when compared to patients with non-biological DMARDs. The use of MTX remains the only drug that has independently shown a beneficial effect on mortality.
authors.affiliation: Department of Rheumatology and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Rodriguez-Rodriguez
authors.affiliation: Department of Rheumatology and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Madrid; and Universidad Camilo José Cela, Madrid, Spain. lleon.hcsc@salud.madrid.org.
authors.forename: Leticia
authors.initials: L
authors.lastname: Leon
authors.affiliation: Department of Rheumatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Ivorra-Cortes
authors.affiliation: Department of Rheumatology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Gómez
authors.affiliation: Department of Rheumatology and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Jose Ramon
authors.initials: JR
authors.lastname: Lamas
authors.affiliation: Department of Rheumatology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Pato
authors.affiliation: Department of Rheumatology, Hospital Clínico San Carlos, Madrid; and Department of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: Juan Ángel
authors.initials: JÁ
authors.lastname: Jover
authors.affiliation: Department of Rheumatology and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Lydia
authors.initials: L
authors.lastname: Abásolo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000401:mortality*; D001685:Biological Factors / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors; D008727:Methotrexate