Life Expectancy and Treatment With Anti-TNF Therapy in RA Patients

Arthur Kavanaugh, MD

Disclosures

November 06, 2006

Question

Are there any recent publications discussing life expectancy in rheumatoid arthritis (RA)? Has this been affected at all by anti-tumor necrosis factor (TNF) therapy, or is it too early to tell?

Henry Roth, MD

Response From the Expert

Arthur Kavanaugh, MD 
Arthur Kavanaugh, MD, Professor, Internal Medicine, University of California at San Diego

 

 

One of the key aspects of the use of TNF inhibitors is their overall risk/benefit ratio. While almost all clinicians are quite familiar with the potentially very positive clinical responses achieved among substantial numbers of treated patients, there remains concern about toxicities, including potentially serious toxicities such as infection and malignancy. Perhaps a very crude estimate of risk/benefit ratio would be overall mortality. On the one hand, by effectively controlling systemic inflammation, therapy with TNF inhibitors could be hypothesized to improve mortality, as it has been established that patients with the most severe RA have accelerated mortality. On the other hand, if serious adverse effects were common, this could have a deleterious effect on overall mortality. Several studies that have begun to address this seem to agree that overall, treatment with TNF inhibitors has a beneficial effect on mortality. To date, these studies have only been published in abstract form; hopefully the full papers will be published soon.

Data from Fred Wolfe's National Data Bank analyzed 22,545 RA patients from across the United States over 85,691 patient-years of follow-up.[1] The 1713 deaths that occurred were assessed to determine factors associated with this outcome. Of note, compared with patients not receiving TNF inhibitors or methotrexate (MTX), the use of TNF inhibitors, the use of MTX, and the use of TNF inhibitors plus MTX were all associated with statistically significantly lower risks for death. From the South of Sweden registry,[2] 1534 patients, 949 of whom were on TNF inhibitors, were assessed for factors associated with mortality. Overall, patients on TNF inhibitors had a slightly lower mortality rate that was not statistically significant compared with those not on TNF inhibitors. However, when adjusted for disease severity, using the Health Assessment Questionnaire score, TNF-inhibitor treated patients had a significantly lower mortality.

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