Researchers found that risk of adverse events and mortality did not increase following certain rheumatoid arthritis (RA) treatments.
Among individuals with rheumatoid arthritis (RA), beginning use of disease‐modifying antirheumatic drugs (DMARDs) was linked to stable adverse events (AEs) and mortality rates.
These findings were published in Immunity, Inflammation and Disease, where the study authors also found a good safety profile for the treatment after being introduced.
To come to these results, the authors used the Taiwan National Health Insurance Database to identify 41,821 patients who had incident RA between 2000 and 2017.
The study was broken down into phases, with phase 1 between 2000 and 2002, phase 2 between 2003 and 2012, and phase 3 between 2013 and 2017.
All 41,821 patients were prescribed conventional DMARDs (cDMARDs) in phase 1. Later, between 1% and 3% of patients were prescribed either a TNF inhibitor (TNFi) in phase 2 or ortho-methoxyamphetamine (OMA) in phase 3. Levels and trends from phases 2 and 3 were compared with those of phase 1 using interrupted time series (ITS) analysis.
In the study sample, the authors found a cancer incidence rate of 1.9% with a mortality rate of 4.19%.
Additionally, 1‐year incident rate of gastrointestinal (GI) bleeding and 3‐year incident rates of other AEs and mortality were calculated and adjusted using propensity score‐based stabilized weights.
AEs of interest included acute myocardial infarction, congestive heart failure, ischemic stroke or transient ischemic attack, overall thromboembolism, tuberculosis, total hip replacement, total knee replacement (TKR), cancer, and all‐cause mortality.
After starting cDMARD treatment, 1‐year GI bleeding rate started to decrease among patients with RA, and remained stable after using biologic DMARDs (bDMARDs).
Additionally, after initiating TNFi use, there was a steady or mild decrease in all 3-year AE trends except for TKR. According to ITS analysis, the trend of TKR incidence mildly increased by 0.13% during phase 2 compared with phase 1 (P = .0322), and trends became steady in phase 3.
“However, TKR started to decrease among patients with RA after cDMARD treatment became available and the slope significantly increased after TNFi introduction, whereas the incidence rate of THR exhibited a steady trend after both cDMARDs and bDMARDs treatment,” the authors explained.
While there are multiple limitations to this research, the authors determined that trends in most measured AEs and mortality were generally steady and mildly decreased after patients with RA began use of cDMARDs and bDMARDs, and risk of AEs and mortality did not increase after treatment.
Reference
Fang YF, Liu JR, Chang SH, Kuo CF, See LC. Trends of adverse events and mortality after DMARDs in patients with rheumatoid arthritis: Interrupted time-series analysis. Immun Inflamm Dis. 2022;10(7):e630. doi:10.1002/iid3.630
AI in Health Care: Closing the Revenue Cycle Gap
April 1st 2025This commentary explores the current state, challenges, and potential of artificial intelligence (AI) in health care revenue cycle management, emphasizing collaboration, data standardization, and targeted implementation to enhance adoption.
Read More
Managed Care Reflections: A Q&A With Hoangmai H. Pham, MD, MPH
April 1st 2025To mark the 30th anniversary of The American Journal of Managed Care® (AJMC®), each issue in 2025 will include a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The April issue features a conversation with Hoangmai H. Pham, MD, MPH, a member of AJMC’s editorial board and the president and CEO of the Institute for Exceptional Care (IEC).
Read More
Bridging Care Gaps With a Systemwide Value-Based Care Strategy
March 29th 2025Mapping care management needs by defining patient populations and then stratifying them according to risk and their needs can help to spur the transformation of a siloed health care system into an integrated system that is able to better provide holistic, value-based care despite the many transitions that continue among hospital, primary, specialty, and community care environments.
Read More