Background/Purpose: This study was conducted in a large health care claims database to determine whether there is a difference in the incidence rate (IR) of pulmonary embolism (PE) among the bDMARD-treated rheumatoid arthritis (RA) population compared with the non–bDMARD-treated RA population and the general non-RA population.

Methods: This retrospective cohort study was performed using a large health care claims database (2001-2013). The study consisted of three cohorts: RA biologic treated, RA biologic naive, and general non-RA population. These cohorts were matched by age and sex. Patients were considered bDMARD exposed if they had one or more prescription claims for a biologic DMARD continuously for at least 90 days after the first RA diagnosis, and they were considered bDMARD naive if they had no bDMARD claims at any time after the first RA diagnosis and 365 days before the first RA diagnosis. The non-RA cohort consisted of those who did not have any exposure to bDMARDs or any arthritis diagnosis claims throughout the study period. Patients who were younger than 18 years of age or who had a history of PE were excluded. Cox regression analysis was used to derive the incidence rate ratio (IRR) comparing the 3 study cohorts, adjusting for age, sex, baseline comorbidity score, and oral steroid use.

Results: For each of the 3 cohorts, 25,373 patients were identified. Most patients were female (~70%) and 34 to 65 years of age (~75%). Certain comorbidities (CHF, CV disease, and diabetes) were seen more often in the RA population than in the general population. The IR of PE was 0.38 (95% CI, 0.33-0.44) in bDMARD-treated patients, 0.31 (95% CI, 0.27-0.34) in bDMARD-naive patients, and 0.10 (95% CI, 0.07-0.14) in the general population per 100 person-years. The adjusted IRR of PE for bDMARD-treated patients was 2.3 times that for the general population (p < 0.0001; 95% CI, 1.59-3.23) and 1.05 times that for non-bDMARD RA patients (p = 0.5743; 95% CI, 0.88-1.25). The adjusted IRR of PE for non-bDMARD RA patients was 2.2 times that for the general population (p < 0.0001; 95% CI, 1.53-3.04). Age (p < 0.0001, IRR = 1.03; 95% CI, 1.022-1.037), baseline comorbidity score (p < 0.0001, IRR = 1.17; 95% CI, 1.13-1.20), and baseline oral steroid use (p< 0.0001, IRR = 1.43; 95% CI, 1.20-1.71) were all significantly associated with the risk for PE.

Conclusion: The IR of PE was 2-fold to 3-fold higher in the RA population than in the general population. However, after adjusting for baseline covariates, we did not identify any statistical difference between bDMARD-treated and bDMARD-naive RA patients. Age, steroid use, and comorbidities are important risk factors for PE in RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/analysis-of-incidence-rates-of-pulmonary-embolism-in-the-rheumatoid-arthritis-population-compared-with-the-non-rheumatoid-arthritis-population/