Combination effect of anti-rheumatic medications for coronary artery diseases risks in rheumatoid arthritis: a nationwide population-based cohort study

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Combination effect of anti-rheumatic medications for coronary artery diseases risks in rheumatoid arthritis: a nationwide population-based cohort study
Key Take-Away: 

Out of the severe complexities of rheumatoid arthritis (RA), the coronary artery diseases (CAD) leads. Amid anti-rheumatoid therapies, DMARDs and COXi are linked with lessened cardiovascular disease, but it is uncertain that the combination of both reduces the CAD risk or vice versa. This population-based cohort study highlights the combination consequences on cardiovascular health.

Introduction
To discover whether the anti-rheumatic drugs combination is linked with the coronary artery diseases (CAD) among patients with incident rheumatoid arthritis (RA).

 

Methods
This population-based cohort study utilised administrative data to categorised 6260 newly-diagnosed RA patients with an age of ≥20 years as the study group. The appearance of CAD according to the ICD-9-CM codes was taken as study end-point. The assessment of exposure to various drugs combinations and related risk of CAD was done. These involved multiple combinations of methotrexate (MTX), sulfasalazine (SSZ), celecoxib (Cx) and hydroxychloroquine (HCQ). The reference group included patients who were never used Cx, HCQ, MTX, or SSZ. Estimation of the hazard ratio (HR) of disease was done via Cox proportional hazards model after adjusting demographic and other co-morbidities. When the proportionality theory was disrupted, the spline curve of the Scaled Schoenfeld residuals was implemented to illustrate the estimated impact on CAD overtime for drug usage.

 

Results
The RA patients exhibited 0.29 (0.19–0.44), 0.46 (0.24–0.88), and 0.42 (0.24– 0.75) adjusted HR (95% confidence interval) of CAD for “Cx only”, “Cx and HCQ ever”, and “Cx, HCQ, MTX, and SSZ ever” respectively throughout the first phase of 0–3, 4, or 7 years. During the second time of 3, 4, or 7–10 years, they shifted to 1.04 (0.78–1.38), 1.16 (0.62–2.19), and 0.59 (0.32–1.08), respectively. The “Cx, MTX, and SSZ ever” showed constant adjusted HR (95% CI) at 0.12 (0.02–0.89).

 

Conclusions
Celecoxib-DMARDs drug combinations were correlated with lowered CAD risk on incident RA patients, and some of them presented the time-varying drug impact.

Source

Curr Med Res Opin

Link to the source

https://www.tandfonline.com/doi/abs/10.1080/03007995.2018.1492910?journalCode=icmo20

Original title of article:

Combination effect of anti-rheumatic medications for coronary artery diseases risk in rheumatoid arthritis: a nationwide population-based cohort study.

Authors:

Yao-Min Hung et al.

Therapeutic, Methotrexate, Sulfasalazine, Celecoxib, Hydroxychloroquine, Rheumatoid Arthritis, DMARDs, COXi, Population-based Cohort Study, Safety
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