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Merck

Cardiovascular risk in rheumatoid arthritis: comparing TNF-α blockade with nonbiologic DMARDs.

The American journal of medicine (2013-07-28)
Daniel H Solomon, Jeffrey R Curtis, Kenneth G Saag, Joyce Lii, Lang Chen, Leslie R Harrold, Lisa J Herrinton, David J Graham, Mary K Kowal, Bindee Kuriya, Liyan Liu, Marie R Griffin, James D Lewis, Jeremy A Rassen
RESUMEN

Elevated tumor necrosis factor (TNF)-α likely contributes to the excess cardiovascular risk observed in rheumatoid arthritis. We compared the cardiovascular risk in rheumatoid arthritis patients starting a TNF-α blocking agent versus a nonbiologic disease-modifying antirheumatic drug (nbDMARD). Subjects with rheumatoid arthritis participating in several different US insurance programs between 1998 and 2007 who received methotrexate were eligible. Those who added a TNF-α blocking agent were compared with subjects who added a nbDMARD in Cox regression models stratified by propensity score decile and adjusted for oral glucocorticoid dosage. We examined the composite cardiovascular end point of myocardial infarction, stroke, or coronary re-vascularization after 6 months. We compared 8656 new users of a nbDMARD with 11,587 new users of a TNF-α blocking agent with similar baseline covariates. Incidence rates per 100 person-years for the composite cardiovascular end point were 3.05 (95% confidence interval [CI], 2.54-3.65) for nbDMARDs and 2.52 (95% CI, 2.12-2.98) for TNF-α blocking agents. The hazard ratio (HR) for the TNF-α blocking agent compared with nbDMARD carrying the first exposure forward was 0.80 (95%, CI 0.62-1.04), while the HR for the as-treated analysis was 0.71 (95% CI, 0.52-0.97). The potential cardiovascular benefit of TNF-α blocking agents was strongest among individuals ≥65 years of age (HR 0.52; 95% CI, 0.34 -0.77; P for interaction = 0.075). Among subjects with rheumatoid arthritis, TNF-α blocking agents may be associated with a reduced risk of cardiovascular events compared with an nbDMARD. Randomized controlled clinical trials should be considered to test this hypothesis.

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Metotrexato hydrate, ≥98% (HPLC), powder
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Metotrexato hydrate, powder, BioReagent, suitable for cell culture, ≥98% (HPLC)
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Methotrexate solution, 1.0 mg/mL in methanol with 0.1N NaOH, ampule of 1 mL, certified reference material, Cerilliant®
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Metotrexato hydrate, ≥99.0% (sum of enantiomers, HPLC)
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Metotrexato hydrate, meets USP testing specifications
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Methotrexate, European Pharmacopoeia (EP) Reference Standard
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Methotrexate for peak identification, European Pharmacopoeia (EP) Reference Standard
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