Background/Purpose: Several studies have evaluated mortality risk factors in rheumatoid arthritis (RA) but that are no data regarding baseline predictors of mortality in patients under biologic therapy. In fact, definition of these predictors is difficult due to many confounding variables such as age, gender, biologic drug itself and its duration. Therefore, the aim of this study was to identify clinical and laboratory baseline predictors of death in RA patients matched for all these parameters under biologic treatment.

Methods: This was a retrospective observational study that included all deceased RA patients (ACR classification criteria) regularly followed in the biologic therapy center of Rheumatology Division of a tertiary university hospital. All relevant parameters were evaluated using an electronic chart database established from 2007 to 2016. All biologic drugs, including subcutaneous and intravenous agents, are regularly administered in-hospital. A control group of RA patients under biologic treatment matched for gender, age, biologic drug and its duration was included. Demographic data, comorbidities, clinical and laboratorial findings and concomitant treatment were assessed at the baseline of last biologic drug and at the last visit before death.

Results: During the study, 22/436 (5%) RA patients died after biologic therapy start. Causes of death included infections in 18 (82%), complications of pulmonary fibrosis in 2 (9%), subarachnoid hemorrhage in 1 (4.5%) and hemorrhagic stroke in 1 (4.5%). Deceased and survivors patients were comparable with regard to current age (57 vs. 57 years, p=0.34), male gender (27% vs. 27%, p=1.0) and last biologic duration (12 vs. 10 months, p=0.51). Analysis of baseline therapeutic parameters of the last biologic drug in the deceased group compared to survival groups revealed similar median number of biologic agents (p=0.94), need of at least one switching to another biologic agent (68% vs. 63, P=0.79) and frequencies of other drugs [prednisone (p=0.25), methotrexate (p=0.8), leflunomide (p=0.79) or sulfasalazine (p=0.11)]. Likewise, clinical and laboratorial characteristics were alike in both groups [Disease Activity Score in 28 joints (DAS28) (4.75 vs 4.96, p=0.75), HAQ (1.75 vs. 1.185, p=0.37), RF (68% vs. 84%, p=0.2) and anti-CCP (18% vs. 21%, p=1.0]. Concerning associated comorbidities, deceased patients had a significantly higher frequency of chronic renal failure (18% vs. 2%, p=0.041) and a trend for a higher frequency of osteoporosis (59% vs. 33%, p=0.062) compared to the control group. Further analysis of all parameters at last visit before death demonstrated that deceased group had a higher DAS28 (3.84 vs. 3.06, p=0.05) and Health Assessment Questionnaire (HAQ) (1.563 vs. 1.0, p=0.0054).

Conclusion: The present study design with rigorous control for confounding factors identified solely chronic renal failure and possibly osteoporosis (in non elderly population) as the most important baseline predictors of mortality in RA patients starting biologic therapy in a real life setting. High RA activity and severity at the last visit before death are short-term predictors of death in patients already under biologic therapy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-mortality-in-ra-patients-before-biologic-therapy/