Biologics may prevent premature death in people with rheumatoid arthritis, study suggests

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, limitation of motion and loss of function of multiple joints. Though joints are the principal areas affected by RA, inflammation can develop in other organs as well. Patients with rheumatoid arthritis have an increased mortality rate. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Biologic agents such as anti-tumor necrosis factor drugs (commonly called anti-TNF) are prescribed to control inflammation and prevent joint damage caused by RA. Biologics are also effective at reducing pain and improving physical function. Researchers from the Arthritis Research Centre of Canada, University of British Columbia, evaluated if the benefits of reducing inflammation lead to a lowered risk of premature death in people with rheumatoid arthritis.

Researchers reviewed patient data from the Canadian Ministry of Health. The study included all reported RA cases that received care between January 1996 and March 2006. Cases were followed until March 2010. All health care services used -- including medications, hospitalizations and lab tests from January 1990 -- were evaluated.

Patients who used a biologic agent during follow-up were placed in one group. Each patient in this biologic group was then matched to a patient from a control group who never used a biologic agent, but was treated with at least three disease-modifying antirheumatic drugs, such as methotrexate (Rheumatrex®, Trexall®), leflunomide (Arava®), hydroxychloroquine (Plaquenil®), sulfasalazine (Azulfidine®) or gold, and had changed DMARD therapy within the last six months. Additional match criteria included age, sex, calendar year of study inclusion and markers of RA disease severity identified in administrative data.

To reduce study bias, researchers took into consideration differences in disease severity, and other factors that may influence the risk of premature death, between the two groups. Researchers evaluated the risk of premature death associated with biologic treatment measured daily from the time of starting biologic until death or until the end of follow-up. Exposure was defined as therapy use from the beginning of treatment and up to three months after therapy was discontinued.

The study evaluated 4,312 total participants, of which 2,156 were biologic users and 2,156 were matched controls. The participants' mean age was 56 years-old and 74.7 percent of participants were female. The researchers observed 573 deaths of which 326 were in the control group and 247 in the biologic users group. The study revealed that exposure to biologics was associated with a 25 percent reduction in risk of premature death compared to no biologic use. Study limitations include the fact that the treatment studied was not randomly assigned, therefore there may have some selection bias that makes people who received biologic treatment different from those who did not; and the results may also have been influenced by factors that the researchers were not able to be measure using administrative data.

"Since people with rheumatoid arthritis are at increased risk of dying prematurely, knowing that the medications used to treat the disease reduce risk of [premature] death is meaningful for people living with RA and their physicians," says Diane Lacaille, MD, FRCPC, MHSC, lead investigator of the study, senior scientist and associate professor at the Arthritis Research Centre of Canada, University of British Columbia. "Specifically, the study results will help people weigh the risks and benefits of these medications when they are deciding whether to start taking them to treat the disease."

Patients should talk to their rheumatologists to determine their best course of treatment.

Funding for this study was provided by the Canadian Institute of Health Research.