Impact of DMARD treatment and systemic inflammation on all-cause mortality in patients with rheumatoid arthritis and interstitial lung disease : a cohort study from the German RABBIT register
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
OBJECTIVES: To investigate the impact of disease activity and treatment with disease-modifying antirheumatic drugs (DMARDs) on all-cause mortality in patients with rheumatoid arthritis and prevalent interstitial lung disease (RA-ILD).
METHODS: Patients with RA-ILD were selected from the biologics register Rheumatoid Arthritis: Observation of Biologic Therapy (RABBIT). Using time-varying Cox regression, the association between clinical measures and mortality was investigated. The impact of DMARDs was analysed by (1) Cox regression considering cumulative exposure (ie, treatment months divided by total months) and (2) time-varying Cox regression as main approach (treatment exposures at monthly level).
RESULTS: Out of 15 566 participants, 381 were identified as RA-ILD cases with 1258 person-years of observation and 2.6 years median length of follow-up. Ninety-seven patients (25.5%) died and 34 (35.1%) of these were not receiving DMARD therapy at the time of death. Higher inflammatory biomarkers but not swollen and tender joint count were significantly associated with mortality. Compared with tumour necrosis factor inhibitors (TNFi), non-TNFi biologic DMARDs (bDMARDs) exhibited adjusted HRs (aHRs) for mortality below 1, lacking statistical significance. This finding was stable in various sensitivity analyses. Joint aHR for non-TNFi biologics and JAKi versus TNFi was 0.56 (95% CI 0.33 to 0.97). Receiving no DMARD treatment was associated with a twofold higher mortality risk compared with receiving any DMARD treatment, aHR 2.03 (95% CI 1.23 to 3.35).
CONCLUSIONS: Inflammatory biomarkers and absence of DMARD treatment were associated with increased risk of mortality in patients with RA-ILD. Non-TNFi bDMARDs may confer enhanced therapeutic benefits in patients with RA-ILD.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:10 |
|---|---|
| Enthalten in: |
RMD open - 10(2024), 2 vom: 04. Apr. |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Rudi, Tatjana [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 08.04.2024 Date Revised 11.04.2024 published: Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1136/rmdopen-2023-003789 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM370697502 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM370697502 | ||
| 003 | DE-627 | ||
| 005 | 20240411232623.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240406s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1136/rmdopen-2023-003789 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1372.xml |
| 035 | |a (DE-627)NLM370697502 | ||
| 035 | |a (NLM)38580343 | ||
| 035 | |a (PII)e003789 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Rudi, Tatjana |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Impact of DMARD treatment and systemic inflammation on all-cause mortality in patients with rheumatoid arthritis and interstitial lung disease |b a cohort study from the German RABBIT register |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 08.04.2024 | ||
| 500 | |a Date Revised 11.04.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a OBJECTIVES: To investigate the impact of disease activity and treatment with disease-modifying antirheumatic drugs (DMARDs) on all-cause mortality in patients with rheumatoid arthritis and prevalent interstitial lung disease (RA-ILD) | ||
| 520 | |a METHODS: Patients with RA-ILD were selected from the biologics register Rheumatoid Arthritis: Observation of Biologic Therapy (RABBIT). Using time-varying Cox regression, the association between clinical measures and mortality was investigated. The impact of DMARDs was analysed by (1) Cox regression considering cumulative exposure (ie, treatment months divided by total months) and (2) time-varying Cox regression as main approach (treatment exposures at monthly level) | ||
| 520 | |a RESULTS: Out of 15 566 participants, 381 were identified as RA-ILD cases with 1258 person-years of observation and 2.6 years median length of follow-up. Ninety-seven patients (25.5%) died and 34 (35.1%) of these were not receiving DMARD therapy at the time of death. Higher inflammatory biomarkers but not swollen and tender joint count were significantly associated with mortality. Compared with tumour necrosis factor inhibitors (TNFi), non-TNFi biologic DMARDs (bDMARDs) exhibited adjusted HRs (aHRs) for mortality below 1, lacking statistical significance. This finding was stable in various sensitivity analyses. Joint aHR for non-TNFi biologics and JAKi versus TNFi was 0.56 (95% CI 0.33 to 0.97). Receiving no DMARD treatment was associated with a twofold higher mortality risk compared with receiving any DMARD treatment, aHR 2.03 (95% CI 1.23 to 3.35) | ||
| 520 | |a CONCLUSIONS: Inflammatory biomarkers and absence of DMARD treatment were associated with increased risk of mortality in patients with RA-ILD. Non-TNFi bDMARDs may confer enhanced therapeutic benefits in patients with RA-ILD | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a arthritis, rheumatoid | |
| 650 | 4 | |a biological therapy | |
| 650 | 4 | |a inflammation | |
| 650 | 4 | |a risk factors | |
| 650 | 4 | |a tumor necrosis factor inhibitors | |
| 650 | 7 | |a Antirheumatic Agents |2 NLM | |
| 650 | 7 | |a Tumor Necrosis Factor-alpha |2 NLM | |
| 650 | 7 | |a Biological Factors |2 NLM | |
| 650 | 7 | |a Biological Products |2 NLM | |
| 650 | 7 | |a Biomarkers |2 NLM | |
| 700 | 1 | |a Zietemann, Vera |e verfasserin |4 aut | |
| 700 | 1 | |a Meissner, Yvette |e verfasserin |4 aut | |
| 700 | 1 | |a Zink, Angela |e verfasserin |4 aut | |
| 700 | 1 | |a Krause, Andreas |e verfasserin |4 aut | |
| 700 | 1 | |a Lorenz, Hanns-Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Kneitz, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Schaefer, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Strangfeld, Anja |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t RMD open |d 2015 |g 10(2024), 2 vom: 04. Apr. |w (DE-627)NLM254089658 |x 2056-5933 |7 nnns |
| 773 | 1 | 8 | |g volume:10 |g year:2024 |g number:2 |g day:04 |g month:04 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1136/rmdopen-2023-003789 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 10 |j 2024 |e 2 |b 04 |c 04 | ||