Date: Sunday, November 8, 2015
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: It is a well-known fact the decline of life expectancy in Rheumatoid Arthritis (RA) being the increased mortality in these patients a constant concern in Rheumatology. This increment in mortality has been linked to multiple factors such as disease activity and treatment. The purpose of our study was to assess the mortality rate and to evaluate the mortality risk in a cohort of RA patients with and without Biologic Agents (BA). Other factors associated to mortality risk were also investigated.
Methods: An inception cohort of RA patients diagnosed between January 2000 and December 2004, were recruited from a Rheumatology outpatient clinic of a tertiary Hospital in Madrid, Spain, and followed for up to 13.5 years after diagnosis. Dependent variable was death (obtained from the National Death Index) and independent variable was use of BA. Covariables: sociodemographic (age, sex, level of studies), clinical (DAS-28, HAQ, hospital admissions, comorbidity, rheumatoid factor [RF]) and therapy (concomitant corticoids, Disease Modifying Antirheumatic Drugs [DMARDs] and BA). Survival techniques were used to estimate the mortality rate (MR) in our cohort, expressed per 1,000 patient-years with their respective confidence interval [95 % CI]. They were follow-up until lost of follow-up, death or end of the study. The influence BA on mortality rate was analyzed using multivariable Cox proportional hazards models adjusting by age, sex, disability, comorbidity, calendar year, disease severity and other variables. BA were used in a time-dependent manner. Results were expressed by hazard ratio (HR) and 95% CI.
Results: We included 576 patients and 711 courses of therapy. 75% were women with a mean age at diagnosis of 59±years. The mean DAS and HAQ at diagnosis were 3.8±1.2 and 0.7±0.6 respectively. 68% patients were taking corticoids, 113 (19.6%) BA and 86% DMARDs (median [p25-75]: 2 [1-3]), being MTX the most prevalent (70%). There were 133 deaths per 5,441 person-years at risk in the total cohort. MR was estimated in 27 [22.5-31.6]. MR for BA was 12.6 [6-26] and for the rest 28.4 [23.8-33.8]. The unadjusted HR of mortality in BA was 0.37 [0.17-0.8] (p=0.011). Controlling by confounders (age, gender, calendar time, comorbidity, disease activity, quality of life), the HR for death in those treated with BA was 0.72 [0.3-1.6], p=0.4) versus those not treated. Other variables independently associated with death were: age at diagnosis (HR: 1.09 [1.07-1.11]), positive RF (HR: 1.94 [1.3-2.8]), hospital admissions (HR: 1.19 [1.12-1.25]), HAQ > 1.5 (HR: 1.98 [1.07-3.6]) and MTX use (HR: 0.4 [0.29-0.66]).
Conclusion: This study describes mortality rate in real-life conditions in an inception cohort of RA patients. After controlling by factors that influence mortality, we found that survival in patients receiving BA is not different than those receiving other classic DMARDs. We have assessed the role of other variables in the risk of mortality.
To cite this abstract in AMA style:Leon L, Rodriguez-Rodriguez L, Gomez-Gomez A, Macarrón P, Blanco M, Jover JA, Abasolo L. Treatment with Biologic Agents in Rheumatoid Arthritis and Mortality Risk in Clinical Practice [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/treatment-with-biologic-agents-in-rheumatoid-arthritis-and-mortality-risk-in-clinical-practice/. Accessed September 22, 2019.
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