The association of TNF inhibitor use with incident cardiovascular events in radiographic axial spondyloarthritis.

Autor: Liew JW; Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA. Electronic address: jwliew@bu.edu., Treu T; Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA., Park Y; Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA., Ferguson JM; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA., Rosser MA; Duke University, Department of Anesthesiology, Durham, NC, USA., Ho YL; Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA., Gagnon DR; Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA., Stovall R; Division of Rheumatology, University of Washington, Seattle, WA, USA., Monach P; Rheumatology Section, VA Boston Healthcare System, Boston, MA, USA., Heckbert SR; Department of Epidemiology, University of Washington, Seattle, WA, USA., Gensler LS; Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA., Liao KP; Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA, VA Boston Healthcare System, Boston, MA, USA; Section of Rheumatology, VA Boston Healthcare System; Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA., Dubreuil M; Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, VA Boston Healthcare System, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Seminars in arthritis and rheumatism [Semin Arthritis Rheum] 2024 Oct; Vol. 68, pp. 152482. Date of Electronic Publication: 2024 Jun 02.
DOI: 10.1016/j.semarthrit.2024.152482
Abstrakt: Background: Whether tumor necrosis factor inhibitor (TNFi) use is cardioprotective among individuals with radiographic axial spondyloarthritis (r-axSpA), who have heightened cardiovascular (CV) risk, is unclear. We tested the association of TNFi use with incident CV outcomes in r-axSpA.
Methods: We identified a r-axSpA cohort within a Veterans Affairs database between 2002 and 2019 using novel phenotyping methods and secondarily using ICD codes. TNFi use was assessed as a time-varying exposure using pharmacy dispense records. The primary outcome was incident CV disease identified using ICD codes for coronary artery disease, myocardial infarction or stroke. We fit Cox models with inverse probability weights to estimate the risk of each outcome with TNFi use versus non-use. Analyses were performed in the overall cohort, and separately in two periods (2002-2010, 2011-2019) to account for secular trends.
Results: Using phenotyping we identified 26,928 individuals with an r-axSpA diagnosis (mean age 63.4 years, 94 % male); at baseline 3633 were TNFi users and 23,295 were non-users. During follow-up of a mean 3.3 ± 4.2 years, 674 (18.6 %) TNFi users had incident CVD versus 11,838 (50.8 %) non-users. In adjusted analyses, TNFi use versus non-use was associated with lower risk of incident CVD (HR 0.34, 95 % CI 0.29-0.40) in the cohort overall, and in the two time periods separately.
Conclusion: In this r-axSpA cohort identified using phenotyping methods, TNFi use versus non-use had a lower risk of incident CVD. These findings provide reassurance regarding the CV safety of TNFi agents for r-axSpA treatment. Replication of these results in other cohorts is needed.
Competing Interests: Declaration of competing interest Jean Liew received grant/research support from Pfizer (over $10,000) for this work. All other authors have nothing to disclose. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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