SANTIAGO, Spain—Rheumatoid arthritis (RA) patients are at increased risk of death due to cardiovascular (CV) disease, cancer, and infection, and there has been concern that TNF-inhibitors might add to these problems because of their association with serious infections, malignancies, and deterioration of heart failure. A new study by Spanish researchers provides reassuring evidence that mortality from all causes is 30% to 50% lower in TNF-treated patients and that CV mortality, particularly in women, is notably reduced. Infection rates were higher in the TNF-treated patients, particularly among those over age 60, but mortality from infections was lower than in the nonTNF-treated patients. The findings appear in an online edition of Annals of Rheumatic Diseases.1

"[The] mortality rate in RA patients who have been treated with TNF antagonists is not different from the general population of similar age and gender. Furthermore, [the] mortality rate in this cohort of patients is clearly reduced compared to RA patients not treated with TNF antagonists, owing to the reduction of deaths from non-infectious causes." —Loreto Carmona, MD, PhD.
"[The] mortality rate in RA patients who have been treated with TNF antagonists is not different from the general population of similar age and gender. Furthermore, [the] mortality rate in this cohort of patients is clearly reduced compared to RA patients not treated with TNF antagonists, owing to the reduction of deaths from non-infectious causes," writes lead author Loreto Carmona, MD, PhD, with the Spanish Foundation of Rheumatology, in Madrid.

Cohort from biologics registry compared to external cohort of RA patients

Dr. Carmona and colleagues compared CV events, cancer and infection rates, and mortality among RA patients treated and not treated with TNF antagonists using data from two nationwide observational cohorts: BIOBADASER and EMERCAR. TNF-treated RA patients were from BIOBADASER, a registry for active long-term follow-up of safety of biological therapies in 4459 rheumatic patients treated with TNF antagonists. As a non-TNF control cohort, the researchers used data from the EMECAR registry, an external RA cohort of 789 patients that was established to define the characteristics of the disease and assess comorbidity. Overall, the study included data on 2869 patient-years of RA patients treated with TNF antagonists and 2433 patient-years for patients not treated with TNF antagonists.

Table. Standardized mortality ratios (SMRs) of RA patients with vs without TNF-inhibitor treatment, compared with general population mortality

Mortality Cause