Association between anti-TNF-alpha therapy and all-cause mortality
Meyers Primary Care Institute; Department of Medicine, Division of Rheumatology
Tumor Necrosis Factor-alpha; Autoimmune Diseases
Immune System Diseases | Pharmacy and Pharmaceutical Sciences
PURPOSE: To compare mortality among patients with selected autoimmune diseases treated with anti-tumor necrosis factor alpha (TNF-alpha) agents with similar patients treated with non-biologic therapies.
METHODS: Cohort study set within several large health care programs, 1998-2007. Autoimmune disease patients were identified using diagnoses from computerized healthcare data. Use of anti-TNF-alpha agents and comparison of non-biologic therapies were identified from pharmacy data, and mortality was identified from vital records and other sources. We compared new users of anti-TNF-alpha agents to new users of non-biologic therapies using propensity scores and Cox proportional hazards analysis to adjust for baseline differences. We also made head-to-head comparisons among anti-TNF-alpha agents.
RESULTS: Among the 46 424 persons included in the analysis, 2924 (6.3%) had died by the end of follow-up, including 1754 (6.1%) of the 28 941 with a dispensing of anti-TNF-alpha agent and 1170 (6.7%) of the 17 483 who used non-biologic treatment alone. Compared to use of non-biologic therapies, use of anti-TNF-alpha therapy was not associated with an increased mortality in patients with rheumatoid arthritis (adjusted hazard ratio [aHR] 0.93 with 95% confidence intervals (CI) 0.85-1.03); psoriasis, psoriatic arthritis, or ankylosing spondylitis (combined aHR 0.81 with CI 0.61-1.06; or inflammatory bowel disease (aHR 1.12 with CI 0.85-1.46). Mortality rates did not differ to an important degree between patients treated with etanercept, adalimumab, or infliximab.
CONCLUSION: Anti-TNF-alpha therapy was not associated with increased mortality among patients with autoimmune diseases.
DOI of Published Version
Pharmacoepidemiol Drug Saf. 2012 Dec;21(12):1311-20. doi: 10.1002/pds.3354. Link to article on publisher's site
Pharmacoepidemiology and drug safety
Herrinton LJ, Liu L, Chen L, Harrold LR, Raebel MA, Curtis JR, Griffin MR, Solomon DH, Saag KG, Lewis JD. (2012). Association between anti-TNF-alpha therapy and all-cause mortality. Meyers Primary Care Institute Publications. https://doi.org/10.1002/pds.3354. Retrieved from https://escholarship.umassmed.edu/meyers_pp/611