Rheumatoid Arthritis and Excess Mortality Associated with Treatments: a Systematic Review and Meta-Analysis

Manon Redondin¹, B Combe², Cécile Gaujoux-Viala³, Jacques Morel⁴ and Cédric Lukas⁵, ¹CHU Lapeyronie, University of Montpellier, France, ²Immuno-Rhumatologie, CHU Lapeyronie, University of Montpellier, France, ³CHU Nîmes, University of Montpellier, France, ⁴Rheumatology, Department of Rheumatology, Montpellier University Hospital, Montpellier, France, ⁵Rheumatology, CHU Lapeyronie and EA2415, Montpellier University, University of Montpellier, France

Meeting: ACR/ARHP Annual Meeting 2016

Date of first publication: September 28, 2016

Keywords: anti-TNF therapy, corticosteroids, methotrexate (MTX), morbidity and mortality and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 15, 2016

Title: Rheumatoid Arthritis – Small Molecules, Biologics and Gene Therapy - Poster III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Patients with rheumatoid arthritis (RA) have a lower life expectancy than general population. The impact of RA treatments on global mortality is not known, and only long-term studies can approach it. Our objective was to assess currently available literature on all-cause mortality associated with treatments in patients with RA.

Methods: We systematically searched available literature (Pubmed, Embase and recent abstracts from ACR and EULAR congresses) for studies reporting observed mortality associated with the use of anti-tumor necrosis factor α (anti-TNFα), methotrexate (MTX) and glucocorticoids (GC) in RA, and having a comparison group. The relative risks of mortality associated with the use of respective treatments were collected and pooled in meta-analysis using Review Manager software (Cochrane collaboration). Random effects meta-analyses were conducted, and forest plots were constructed to summarise the risk ratio estimates and their 95% confidence intervals. Data were extracted by one investigator and confirmed by another.

Results: 13995 articles were of potential interest, and 20 finally met required criteria after screening and were included. Follow-up ranged from 2 to 13 years. 9 articles concerned mortality in RA patients treated with anti-TNFα (102621 patients). Observed mortality was reduced in these patients compared with non-users with pooled risk ratio (RR) at 0.73 [95% confidence interval 0.61-0.87], p=0.0004. Regarding MTX, 5 studies were included in the meta-analysis (25252 patients). Reported mortality was also decreased compared with non-users (RR 0.69 [0.49-0.97], p=0.03). Finally, 6 articles concerned mortality in RA patients treated by GC (45292 patients). In these patients, mortality was found to be increased (figure: RR 1.50 [1.17-1.93], p=0.002).

Conclusion: Despite methodological caveats, especially potential indication biases, currently available literature is in favor of a benefit of anti-TNF and MTX on observed mortality in RA, while the use of GC is associated with an increased risk of overall mortality. These data plead for a careful decision making in therapeutic decisions in patients having an apparently controlled disease at the cost of long-term use of GC.

Figure: Pooled risk ratio of observed mortality in patients receiving corticosteroids

Disclosure: M. Redondin, None; B. Combe, None; C. Gaujoux-Viala, None; J. Morel, None; C. Lukas, None.

To cite this abstract in AMA style:

Redondin M, Combe B, Gaujoux-Viala C, Morel J, Lukas C. Rheumatoid Arthritis and Excess Mortality Associated with Treatments: a Systematic Review and Meta-Analysis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/rheumatoid-arthritis-and-excess-mortality-associated-with-treatments-a-systematic-review-and-meta-analysis/. Accessed .

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