Key result
Switching to TNF-α inhibitors was associated with a reduced risk of hospitalization for heart failure compared to switching to another csDMARD regimen (aHR 0.59; 95% CI 0.35-0.97).
Why the study?
The study aimed to compare the risk of heart failure in patients with rheumatoid arthritis treated with TNF-α inhibitors versus conventional synthetic disease-modifying anti-rheumatic drugs.
Do TNF-α inhibitors reduce hospitalization for heart failure in patients with rheumatoid arthritis who failed prior csDMARD therapy compared to switching to another csDMARD?
Cohort (n=3,210)
Yes
Do TNF-α inhibitors reduce hospitalization for heart failure in patients with rheumatoid arthritis who failed prior csDMARD therapy compared to switching to another csDMARD?
Hazard Ratio: 0.59 (95% CI 0.35–0.97)
Absolute Event Rate: 3.66% vs 4.72%
In patients with rheumatoid arthritis who failed prior csDMARDs, switching to TNF-α inhibitors is associated with a reduced risk of heart failure hospitalization compared to switching to another csDMARD.
May support TNF-α inhibitor preference in RA with HF risk; hypothesis-generating and requires randomized confirmation.
This is a retrospective cohort study by analyzing a multi-institutional electronic medical records database covering 1.3 million individuals (6% of Taiwan's population) to compare the risk of heart failure (HF) in patients with rheumatoid arthritis (RA) treated with tumor necrosis factor-α (TNF-α) inhibitors or conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). We included patients with RA aged 20 years and older who had treatment failure with at least 2 different csDMARD regimens and newly switched to another csDMARD regimen or TNFis from 2009 to 2019. We followed patients from initiation of the new therapies to the occurrence of hospitalization for heart failure (hHF), death, to the last clinical visit or December 31, 2020. We performed multivariable Cox proportional hazard models to compare TNF-α inhibitors and csDMARD groups for the risk of hHF, with adjustment for patients' characteristics. A total of 1,278 TNF-α inhibitors and 1,932 csDMARDs treated patients were identified, with 78% being women and having an average age of 55 (SD 13.28) years. The incidence rates of hHF for the TNF-α inhibitors and csDMARD groups were 3.66 and 4.72 per 1,000 person-years, respectively (adjusted hazard ratio (aHR) 0.59; 95% confidence interval (CI) 0.35-0.97), and the results remained consistent in patients both with an HF history (aHR 0.66; 95% CI 0.03-14.46) and without (aHR 0.49; 95% CI, 0.27-0.89). The findings suggest that those who switched to TNF-α inhibitors had a reduced risk of hHF, compared with those who switched to another csDMARD regimen.
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Chen et al. (2021) conducted a cohort in Rheumatoid arthritis (n=3,210). Tumor necrosis factor-α (TNF-α) inhibitors vs. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) was evaluated on Hospitalization for heart failure (hHF) (aHR 0.59, 95% CI 0.35-0.97). Switching to TNF-α inhibitors was associated with a reduced risk of hospitalization for heart failure compared to switching to another csDMARD regimen (aHR 0.59; 95% CI 0.35-0.97).
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