Journal
AMERICAN JOURNAL OF MEDICINE
Volume 128, Issue 5, Pages -Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjmed.2014.11.025
Keywords
Disease-modifying antirheumatic drugs; Rheumatoid arthritis; Venous thromboembolism
Categories
Funding
- National Institutes of Health (NIH) [K23 AR059677]
- Pfizer
- Pharmaceutical Research and Manufacturers of America
- Pharmacoepidemiology Program at the Harvard School of Public Health
- NIH [K24 AR055989, P60 AR047782, R01 AR056215]
- Amgen
- Lilly
- Novartis
- Bristol-Myers Squibb
- NIH
- AstraZeneca
- Agency for Healthcare Research and Quality
- U.S. Food and Drug Administration
- WHISCON
- LLC
- Aetion, Inc
- Boehringer Ingelheim
- Harvard-Brigham Drug Safety and Risk Management Research Contract
Ask authors/readers for more resources
OBJECTIVES: Recent research suggests that rheumatoid arthritis increases the risk of venous thromboembolism. This study compared the risk of venous thromboembolism in patients with newly diagnosed rheumatoid arthritis initiating a biologic disease-modifying antirheumatic drug (DMARD) with those initiating methotrexate or a nonbiologic DMARD. METHODS: We conducted a population-based cohort study using US insurance claims data (2001-2012). Three mutually exclusive, hierarchical DMARD groups were used: (1) a biologic DMARD with and without nonbiologic DMARDs; (2) methotrexate without a biologic DMARD; or (3) nonbiologic DMARDs without a biologic DMARD or methotrexate. We calculated the incidence rates of venous thromboembolism. Cox proportional hazard models stratified by propensity score (PS) deciles after asymmetric PS trimming were used for 3 pairwise comparisons, controlling for potential confounders at baseline. RESULTS: We identified 29,481 patients with rheumatoid arthritis with 39,647 treatment episodes. From the pairwise comparison after asymmetric PS trimming, the incidence rate of hospitalization for venous thromboembolism per 1000 person-years was 5.5 in biologic DMARD initiators versus 4.4 in nonbiologic DMARD initiators and 4.8 in biologic DMARD initiators versus 3.5 in methotrexate initiators. The PS decile-stratified hazard ratio of venous thromboembolism associated with biologic DMARDs was 1.83 (95% confidence interval [CI], 0.91-3.66) versus nonbiologic DMARDs and 1.39 (95% CI, 0.73-2.63) versus methotrexate. The hazard ratio of venous thromboembolism in biologic DMARD initiators was the highest in the first 180 days versus nonbiologic DMARD initiators (2.48; 95% CI, 1.14-5.39) or methotrexate initiators (1.80; 95% CI, 0.90-3.62). CONCLUSIONS: The absolute risk for venous thromboembolism was low in patients with newly diagnosed rheumatoid arthritis. Initiation of a biologic DMARD seems to be associated with an increased short-term risk of hospitalization for venous thromboembolism compared with initiation of a nonbiologic DMARD or methotrexate. (C) 2015 Elsevier Inc. All rights reserved.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available