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Similar Mortality With Different TNF-α Inhibitor Therapies in RA

No mortality differences between adalimumab, etanercept, and infliximab in rheumatoid arthritis

THURSDAY, Aug. 9 (HealthDay News) -- For patients with rheumatoid arthritis there are no significant differences in the overall mortality risk with different tumor necrosis factor-α inhibitor (TNFi) therapies (adalimumab, etanercept, and infliximab), according to a study published online Aug. 8 in Arthritis & Rheumatism.

To examine whether differences in mode of action and safety profiles result in differential mortality risks for adalimumab, etanercept, and infliximab, Julia F. Simard, Sc.D., from the Karolinska Institutet in Stockholm, and colleagues reviewed data from the Swedish Biologics Register ARTIS for patients with rheumatoid arthritis initiating a first-ever biologic therapy between 2003 and 2008. Data from participants treated with adalimumab (1,609 patients), etanercept (2,686 patients), or infliximab (2,027 patients) were linked to information from the national Swedish registers on deaths from any cause, demographics, rheumatoid arthritis characteristics, comorbidities, and concurrent treatment at initiation of TNFi.

The researchers found that, over 19,118 person-years of follow-up, 211 patients died (3.3 percent); 85 percent of these patients were exposed to only one TNFi. There was no significant difference across the exposure groups for overall mortality, regardless of the adjustment and modeling approach used (infliximab versus etanercept relative risk [RR], 1.1 [95 percent confidence interval (CI), 0.7 to 1.7]; adalimumab versus etanercept RR, 1.3 [95 percent CI, 0.9 to 2.0]).

"To conclude, despite well-known differences in the mode of action, and documented differences in the safety profiles of the three TNFi therapies etanercept, adalimumab, and infliximab, these differences did not translate into statistically significant differences in overall mortality among 6,322 patients with rheumatoid arthritis treated in clinical practice," the authors write. "We cannot exclude, however, the existence of differences in mortality across these drugs in certain patient subsets."

The Swedish Biologics Register ARTIS is funded by the pharmaceutical industry.

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