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Kristensen S, Hagelskjær AM, Cordtz R, Bliddal S, Mortensen AS, Nielsen CH, Feldt-Rasmussen U, Lauridsen KB, Dreyer L. Polyautoimmunity in Patients With Anticyclic Citrullinated Peptide Antibody-Positive and -Negative Rheumatoid Arthritis: a Nationwide Cohort Study From Denmark. J Rheumatol 2024; 51:350-359. [PMID: 38302173 DOI: 10.3899/jrheum.2023-0907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE This study aimed to compare the prevalence and incidence of polyautoimmunity between anticyclic citrullinated peptide antibody (anti-CCP)-positive and anti-CCP-negative patients with rheumatoid arthritis (RA). METHODS In a nationwide register-based cohort study, patients with RA (disease duration ≤ 2 yrs) in the DANBIO rheumatology register with an available anti-CCP test in the Register of Laboratory Results for Research were identified. The polyautoimmunity outcome included 21 nonrheumatic autoimmune diseases identified by linkage between the Danish Patient Registry and Prescription Registry. The age- and sex-adjusted prevalence ratio (PR) was calculated by modified Poisson regression to estimate the prevalence at diagnosis in anti-CCP-positive vs anti-CCP-negative patients. The hazard ratio (HR) of polyautoimmunity within 5 years of entry into DANBIO was estimated in cause-specific Cox regression models. RESULTS The study included 5839 anti-CCP-positive and 3799 anti-CCP-negative patients with RA. At first visit, the prevalence of prespecified polyautoimmune diseases in the Danish registers was 11.1% and 11.9% in anti-CCP-positive and anti-CCP-negative patients, respectively (PR 0.93, 95% CI 0.84-1.05). The most frequent autoimmune diseases were autoimmune thyroid disease, inflammatory bowel disease, and type 1 diabetes mellitus. During a mean follow-up of 3.5 years, only a few (n = 210) patients developed polyautoimmunity (HR 0.6, 95% CI 0.46-0.79). CONCLUSION Polyautoimmunity as captured through the Danish National Patient Registry occurred in approximately 1 in 10 patients with RA at time of diagnosis regardless of anti-CCP status. In the years subsequent to the RA diagnosis, only a few and mainly anti-CCP-negative patients developed autoimmune disease.
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Affiliation(s)
- Salome Kristensen
- S. Kristensen, MD, PhD, Center for Rheumatic Research Aalborg and Department of Rheumatology Aalborg University Hospital, and Department of Clinical Medicine, Aalborg University, Aalborg;
| | - Amalie M Hagelskjær
- A.M. Hagelskjær, MD, A.S. Mortensen, BSc, Center for Rheumatic Research Aalborg and Department of Rheumatology, Aalborg University Hospital, Aalborg
| | - René Cordtz
- R. Cordtz, MD, PhD, Center for Rheumatic Research Aalborg and Department of Rheumatology, Aalborg University Hospital, Aalborg, and DANBIO, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup
| | - Sofie Bliddal
- S. Bliddal, MD, PhD, Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Anders S Mortensen
- A.M. Hagelskjær, MD, A.S. Mortensen, BSc, Center for Rheumatic Research Aalborg and Department of Rheumatology, Aalborg University Hospital, Aalborg
| | - Claus H Nielsen
- C.H. Nielsen, MD, DMSc, Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Ulla Feldt-Rasmussen
- U. Feldt-Rasmussen, MD, DMSc, Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Institute of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen
| | - Karen B Lauridsen
- K.B. Lauridsen, MD, Center for Rheumatic Research Aalborg and Department of Rheumatology, and Department of Clinical Immunology, Aalborg University Hospital, Aalborg
| | - Lene Dreyer
- L. Dreyer, MD, PhD, Center for Rheumatic Research Aalborg and Department of Rheumatology, Aalborg University Hospital, and Department of Clinical Medicine, Aalborg University, Aalborg, and DANBIO, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup, and Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark
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Graven-Nielsen CS, Vittrup I, Kragh AJ, Lund F, Bliddal S, Kofoed K, Kristensen S, Stensballe A, Nielsen CH, Feldt-Rasmussen U, Cordtz R, Dreyer L. Polyautoimmunity in patients with cutaneous lupus erythematosus: A nationwide sex- and age-matched cohort study from Denmark. JAAD Int 2023; 13:126-133. [PMID: 37808964 PMCID: PMC10550802 DOI: 10.1016/j.jdin.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 10/10/2023] Open
Abstract
Background Polyautoimmunity is defined as having 2 or more autoimmune diseases. Little is known about polyautoimmunity in patients with cutaneous lupus erythematosus (CLE). Objectives To estimate prevalence and 5-year incidence of non-lupus erythematosus (LE) autoimmune diseases in patients with CLE. Methods Patients with CLE were identified In the Danish National Patient Registry and each patient was age- and sex-matched with 10 general population controls. Outcome information on non-LE autoimmune diseases was obtained by register-linkage between Danish National Patient Registry and the National Prescription Register. The risk ratio (RR) for prevalent non-LE autoimmune disease at time of CLE diagnosis was calculated in modified Poisson regression; and hazard ratios (HRs) for incident non-LE autoimmune disease were estimated in Cox regression analyses. Results Overall, 1674 patients with CLE had a higher prevalence of a non-LE autoimmune disease than the comparators (18.5 vs 7.9%; RR 2.4; 95% CI, 2.1 to 2.6). Correspondingly, the cumulative incidence of a non-LE autoimmune disease during 5 years of follow-up was increased for the patients with CLE: HR 3.5 (95% CI, 3.0 to 4.0). Limitations Risk of detection and misclassification bias, mainly pertaining to the CLE group. Conclusion Patients with CLE had higher prevalence and 5-year cumulative incidence of a non-LE autoimmune disease than the general population.
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Affiliation(s)
| | - Ida.V. Vittrup
- Center for Rheumatology Research Aalborg (CERRA), Aalborg University Hospital, Aalborg, Denmark
| | - Anna J. Kragh
- Center for Rheumatology Research Aalborg (CERRA), Aalborg University Hospital, Aalborg, Denmark
| | - Fredrik Lund
- Center for Rheumatology Research Aalborg (CERRA), Aalborg University Hospital, Aalborg, Denmark
| | - Sofie Bliddal
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Institute of Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | | | - Salome Kristensen
- Center for Rheumatology Research Aalborg (CERRA), Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Denmark
| | - Allan Stensballe
- Department of Health Science and Technology, Aalborg University, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Claus H. Nielsen
- Institute of Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - René Cordtz
- Center for Rheumatology Research Aalborg (CERRA), Aalborg University Hospital, Aalborg, Denmark
| | - Lene Dreyer
- Center for Rheumatology Research Aalborg (CERRA), Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Denmark
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Svensson ALL, Emborg HD, Bartels LE, Ellingsen T, Adelsten T, Cordtz R, Dreyer L, Obel N. Outcomes following SARS-CoV-2 infection in individuals with and without inflammatory rheumatic diseases: a Danish nationwide cohort study. Ann Rheum Dis 2023; 82:1359-1367. [PMID: 37414519 DOI: 10.1136/ard-2023-223974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE In a setting with an extensive SARS-CoV-2 test strategy and availability of effective vaccines, we aimed to investigate if patients with inflammatory rheumatic diseases (IRD) face greater risk of contracting SARS-CoV-2 and have a worse prognosis of increased risk of hospitalisation, assisted ventilation and death compared with the general population. METHODS This was a nationwide, population-based register study that compared outcomes of SARS-CoV-2 infection in Danish patients with IRD (n=66 840) with matched population controls (n=668 400). The study period was from March 2020 to January 2023. Cox regression analyses were used to calculate incidence rate ratios (IRRs) for SARS-CoV-2-related outcomes. RESULTS We observed a difference in time to first and second positive SARS-CoV-2 test in patients with IRD compared with the general population (IRR 1.06, 95% CI 1.05 to 1.07) and (IRR 1.21, 95% CI 1.15 to 1.27). The risks of hospital contact with COVID-19 and severe COVID-19 were increased in patients with IRD compared with population controls (IRR 2.11, 95% CI 1.99 to 2.23) and (IRR 2.18, 95% CI 1.94 to 2.45). The risks of assisted ventilation (IRR 2.33, 95% CI 1.89 to 2.87) and COVID-19 leading to death were increased (IRR 1.98, 95% CI 1.69 to 2.33). Patients with IRD had more comorbidities compared with the general population. A third SARS-CoV-2 vaccination was associated with a reduced need for hospitalisation with COVID-19 and reduced the risk of death. CONCLUSION Patients with IRD have a risk of SARS-CoV-2, which nearly corresponds to the general population but had a substantial increased risk of hospitalisation with COVID-19, severe COVID-19, requiring assisted ventilation and COVID-19 leading to death, especially in patients with comorbidities.
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Affiliation(s)
- Annemarie Lyng Lyng Svensson
- Department of Rheumatology, Center for Rheumatology and Spine Diseases, Rigshospitalet HovedOrtoCentret, Kobenhavn, Denmark
| | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Kobenhavn, Denmark
| | | | | | - Thomas Adelsten
- Department of Rheumatology, Sjællands Universitetshospital Køge, Koge, Denmark
| | - René Cordtz
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Rheumatology, Gentofte Hospital, Hellerup, Denmark
| | - Lene Dreyer
- Department of Rheumatology and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Obel
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Kobenhavn, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Kobenhavn, Denmark
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Faquetti ML, Vallejo-Yagüe E, Cordtz R, Dreyer L, Burden AM. JAK-inhibitors and risk on serious viral infection, venous thromboembolism and cardiac events in patients with rheumatoid arthritis: A protocol for a prevalent new-user cohort study using the Danish nationwide DANBIO register. PLoS One 2023; 18:e0288757. [PMID: 37498856 PMCID: PMC10374052 DOI: 10.1371/journal.pone.0288757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
Janus Kinase inhibitors (JAKis) are targeted synthetic disease-modifying antirheumatic drugs and represent an important alternative to treat patients with moderate to high rheumatoid arthritis (RA) disease activity. Safety concerns associated with increased risk for venous thromboembolism (VTE), serious viral infection, and, more recently, major adverse cardiovascular events (MACE) in JAKi users have emerged worldwide. However, as the exact mechanisms to explain these safety concerns remain unclear, the increased risk of VTE, MACE, and serious viral infection in JAKi users is heavily debated. In light of the need to enrich the safety profile of JAKis in real-world data, we aim to quantify the incidence and risk of MACE, VTE, and serious viral infections in RA patients registered in the Danish DANBIO registry, a nationwide registry of biological therapies used in rheumatology. Therefore, we will conduct a population-based cohort study using a prevalent new-user design. We will identify all RA patients in the DANBIO, ≥ 18 years old, receiving a JAKi or a tumor necrosis factor α inhibitor (TNF-αi) from January 2017 to December 2022. Prevalent and new users of JAKis will be matched to TNF-αi comparators with similar exposure history using time-conditional propensity scores (TCPS). We will describe the cumulative incidence of the outcomes (VTE, MACE, serious viral infection) in each exposure group (JAKi users; TNF-αi users), stratified by outcome type. Additionally, the Aalen-Johansen method will be used to estimate the time-to-event survival function stratified by outcome type. We will also estimate the hazard ratio (HR) with 95% confidence interval (CI) of each outcome in both exposure groups using the time-dependent Cox proportional hazards model. Results will enrich the safety profile of JAKis in real-world data.
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Affiliation(s)
| | - Enriqueta Vallejo-Yagüe
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - René Cordtz
- Center of Rheumatic Research Aalborg, (CERRA), Aalborg University Hospital, Aalborg, Denmark
- DANBIO Register, Aalborg, Denmark
| | - Lene Dreyer
- Center of Rheumatic Research Aalborg, (CERRA), Aalborg University Hospital, Aalborg, Denmark
- DANBIO Register, Aalborg, Denmark
- Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Andrea M Burden
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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5
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Alzubaidi A, Cordtz R, Westermann R, Soussi BG, Lauridsen KB, Kristensen S, Dreyer L. SARS-CoV-2 test patterns in Danish patients with inflammatory rheumatic diseases during the COVID-19 pandemic. Scand J Rheumatol 2023; 52:321-323. [PMID: 36632996 DOI: 10.1080/03009742.2022.2153986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Aha Alzubaidi
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - R Cordtz
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,DANBIO Register, Denmark.,Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - R Westermann
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - B G Soussi
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - K B Lauridsen
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - S Kristensen
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - L Dreyer
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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6
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Lauper K, Iudici M, Mongin D, Bergstra SA, Choquette D, Codreanu C, Cordtz R, De Cock D, Dreyer L, Elkayam O, Hauge EM, Huschek D, Hyrich KL, Iannone F, Inanc N, Kearsley-Fleet L, Kristianslund EK, Kvien TK, Leeb BF, Lukina G, Nordström DC, Pavelka K, Pombo-Suarez M, Rotar Z, Santos MJ, Strangfeld A, Verschueren P, Courvoisier DS, Finckh A. Effectiveness of TNF-inhibitors, abatacept, IL6-inhibitors and JAK-inhibitors in 31 846 patients with rheumatoid arthritis in 19 registers from the 'JAK-pot' collaboration. Ann Rheum Dis 2022; 81:1358-1366. [PMID: 35705376 PMCID: PMC9484385 DOI: 10.1136/annrheumdis-2022-222586] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/26/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND JAK-inhibitors (JAKi), recently approved in rheumatoid arthritis (RA), have changed the landscape of treatment choices. We aimed to compare the effectiveness of four current second-line therapies of RA with different modes of action, since JAKi approval, in an international collaboration of 19 registers. METHODS In this observational cohort study, patients initiating tumour necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6i), abatacept (ABA) or JAKi were included. We compared the effectiveness of these treatments in terms of drug discontinuation and Clinical Disease Activity Index (CDAI) response rates at 1 year. Analyses were adjusted for patient, disease and treatment characteristics, including lines of therapy and accounted for competing risk. RESULTS We included 31 846 treatment courses: 17 522 TNFi, 2775 ABA, 3863 IL-6i and 7686 JAKi. Adjusted analyses of overall discontinuation were similar across all treatments. The main single reason of stopping treatment was ineffectiveness. Compared with TNFi, JAKi were less often discontinued for ineffectiveness (adjusted HR (aHR) 0.75, 95% CI 0.67 to 0.83), as was IL-6i (aHR 0.76, 95% CI 0.67 to 0.85) and more often for adverse events (aHR 1.16, 95% CI 1.03 to 1.33). Adjusted CDAI response rates at 1 year were similar between TNFi, JAKi and IL-6i and slightly lower for ABA. CONCLUSION The adjusted overall drug discontinuation and 1 year response rates of JAKi and IL-6i were similar to those observed with TNFi. Compared with TNFi, JAKi were more often discontinued for adverse events and less for ineffectiveness, as were IL-6i.
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Affiliation(s)
- Kim Lauper
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneve, Switzerland
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Michele Iudici
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Denis Mongin
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Denis Choquette
- Institut de recherche en rhumatologie de Montréal, Montreal, Quebec, Canada
| | - Catalin Codreanu
- Rheumatology, University of Medicine and Pharmacy, Center of Rheumatic Diseases, Bucharest, Romania
| | - René Cordtz
- Departments of Clinical Medicine and Rheumatology, Aarhus University and Aarhus University Hospital, Aalborg, Denmark
- DANBIO, Glostrup, Denmark
| | - Diederik De Cock
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lene Dreyer
- Departments of Clinical Medicine and Rheumatology, Aarhus University and Aarhus University Hospital, Aalborg, Denmark
- DANBIO, Glostrup, Denmark
| | - Ori Elkayam
- Department of Rheumatology, Sackler Faculty of Medicine, Tel Aviv University, Sourasky Medical Center, Tel Aviv, Israel
| | - Ellen-Margrethe Hauge
- Departments of Clinical Medicine and Rheumatology, Aarhus University and Aarhus University Hospital, Aalborg, Denmark
- DANBIO, Glostrup, Denmark
| | - Doreen Huschek
- Epidemiology Unit, German Rheumatism Research Center (DRFZ), Berlin, Germany
| | - Kimme L Hyrich
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Florenzo Iannone
- GISEA, DETO - Rheumatology Unit, University of Bari, Bari, Italy
| | - Nevsun Inanc
- Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Galina Lukina
- V.A. Nasonova Research Institute of Rheumatology, A. S. Loginov Moscow Clinical Scientific Center, Russian Federation, Moscow, Russian Federation
| | - Dan C Nordström
- Departments of Medicine and Rheumatology, ROB-FIN, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Karel Pavelka
- Rheumatology Department, Charles University, Prag, Czech Republic
| | - Manuel Pombo-Suarez
- Rheumatology Service, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Ziga Rotar
- Department of Rheumatology, biorx.si, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maria Jose Santos
- Rheumatology Department, Hospital Garcia de Orta, on behalf of Reuma.pt, Almada, Portugal
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Center (DRFZ), Berlin, Germany
- Charité University Medicine, Berlin, Germany
| | - Patrick Verschueren
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Division of Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
| | - Delphine Sophie Courvoisier
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Axel Finckh
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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Abtahi S, Cordtz R, Dreyer L, Driessen JHM, Boonen A, Burden AM. Biological Disease-Modifying Antirheumatic Drugs and Osteoporotic Fracture Risk in Patients with Rheumatoid Arthritis: A Danish Cohort Study. Am J Med 2022; 135:879-888.e3. [PMID: 35134369 DOI: 10.1016/j.amjmed.2022.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Clinical trials have shown a beneficial effect from biological disease-modifying antirheumatic drugs (bDMARDs) on hand or axial bone loss in patients with rheumatoid arthritis; however, it is unclear if this translates to a reduced fracture risk. We investigated the effect of bDMARDs on osteoporotic fracture risk compared to no biological treatment in rheumatoid arthritis. METHODS A cohort of patients with rheumatoid arthritis aged 18+ from DANBIO was linked to population-based health registries in Denmark (2006-2016). Adopting a prevalent new-user design, we matched bDMARD users to bDMARD-naïve patients using time-conditional propensity scores. The risk of incident osteoporotic fractures (including hip, vertebrae, humerus, and forearm) was estimated among the matched patients by Cox proportional hazards models. RESULTS Out of 24,678 patients with rheumatoid arthritis, 4265 bDMARD users were matched to the same number of bDMARD-naïve patients (mean age 56.2 years, 74% female). During follow-up, 229 osteoporotic fractures occurred among bDMARD users and 205 fractures among bDMARD-naïve patients (incidence rates 12.1 and 13.0 per 1000 person-years, respectively). The use of bDMARDs was not associated with a reduced risk of osteoporotic fractures among patients with rheumatoid arthritis (hazard ratio 0.97, 95% confidence interval 0.78-1.20), compared with no biological treatment. The risk estimates were similar for all osteoporotic fracture sites. CONCLUSION We found no independent beneficial effect from using bDMARDs on reducing the risk of osteoporotic fractures in patients with rheumatoid arthritis.
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Affiliation(s)
- Shahab Abtahi
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - René Cordtz
- Departments of Clinical Medicine and Rheumatology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Lene Dreyer
- Departments of Clinical Medicine and Rheumatology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark; DANBIO - The Danish Rheumatologic Database, Copenhagen, Denmark
| | - Johanna H M Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Andrea M Burden
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands; Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland.
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8
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Cordtz R, Askling J, Delcoigne B, Ekström Smedby K, Baecklund E, Ballegaard C, Isomäki P, Aaltonen K, Gudbjornsson B, Love T, Provan SA, Michelsen B, Sexton J, Dreyer L, Hellgren K. OP0257 RISK OF HAEMATOLOGICAL MALIGNANCY IN PATIENTS WITH PSORIATIC ARTHRITIS, OVERALL AND IN RELATION TO TNF INHIBITORS - A NORDIC COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSeveral autoimmune inflammatory diseases, including rheumatoid arthritis (RA), are associated with increased risk of malignant lymphomas. There is also a longstanding concern of lymphoma development with tumour necrosis factor inhibitor (TNFi) treatment, but most studies in RA to date do not indicate an additionally increased risk. Corresponding studies in psoriatic arthritis (PsA), both with respect to the underlying risks, and risks in relation to treatment with TNFi, are limited. Data on myeloid malignancies in PsA are scarce.ObjectivesTo estimate the risk of haematological malignancy overall and by lymphoid and myeloid types in TNFi treated versus (vs.) biologics-naïve patients with PsA across the five Nordic countries. Additionally, we investigated the underlying risk of haematological malignancies in PsA as compared to the general population.MethodsWe identified patients with PsA starting a first ever TNFi from the clinical rheumatology registers (CRR) in Sweden (SE), Denmark (DK), Norway (NO), Finland (FI), and Iceland (ICE) from 2006 through 2019 (n=10 621). We identified biologics-naïve patients with PsA from a) the CRR (n=18 705, all countries) and b) the national patient registers (NPR, n=27 286, SE and DK only). To estimate the underlying risk of haematological malignancy in PsA, we randomly sampled general population comparators in SE and DK matched on year of birth, sex, and calendar year at start of follow-up, to the patients with PsA.Through linkage to the mandatory national cancer registers in all five countries, we collected information on haematological malignancy overall, and categorised into lymphoid or myeloid types. By applying a modified Poisson regression, we estimated pooled incidence rate ratio (IRR) with 95% confidence intervals (CI) for TNFi treated vs. biologics-naïve PsA and for PsA vs. the general population, adjusted for age (18-55, 56-65, 66-70, >70 years), sex, calendar period (2006-2010, 2011-2019) and country, and using robust standard errors.ResultsWe observed 40 events of haematological malignancies (during 59 827 person-years) among TNFi treated PsA, resulting in a crude incidence rate (IR) of 67 per 100 000 person-years. The corresponding IR was 91 (63 events) for biologics-naïve PsA from the CRR, and 118 (172 events) for biologics-naïve PsA from NPR. This resulted in a pooled IRR of 0.97 (0.69 to 1.37) for TNFi-treated vs. biologics-naïve PsA patients from the CRR, and 0.84 (0.64 to 1.10) vs. biologics-naïve PsA patients from the NPR. The pooled IRR of haematological malignancies in PsA overall vs. the general population was 1.35 (1.17 to 1.55). Throughout, the estimates were largely similar for lymphoid and myeloid malignancies (Figure 1). The crude IR of haematological malignancies were substantially akin across different TNFi agents.Figure 1.Pooled incidence rate ratios (IRRs) (95% CI) of haematological malignancy overall and by lymphoid and myeloid types, in first ever TNFi treated versus biologics-naïve patients with PsA, and versus general population comparators. Legend: Lymphoid malignancies include international classification of diseases (ICD) 10 codes C81-86, C88, C90-91. Myeloid malignancies include ICD10 codes C92-95, D45-D46, D47.1, D47.3-5. Incidence rate ratios adjusted for age (18-55, 56-65, 66-70, >70 years), sex, calendar period (2006-2010, 2011-2019) and country, and using robust standard errors.ConclusionIn this large five-country cohort study, we did not observe any increased risk of haematological malignancies overall, nor for lymphoid and myeloid types, in patients with PsA treated with TNFi. By contrast, there were signals of a moderately increased underlying risk of haematological malignancies, both of lymphoid and myeloid types, in patients with PsA overall as compared to the general population. The findings are of importance from a patient information perspective.AcknowledgementsWe would like to acknowledge the NordForsk and FOREUM, and especially the patient representatives of the NordForsk collaboration for their valuable contribution to this study.Disclosure of InterestsRené Cordtz: None declared, Johan Askling Consultant of: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB, Grant/research support from: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB, Bénédicte Delcoigne: None declared, Karin Ekström Smedby: None declared, Eva Baecklund: None declared, Christine Ballegaard: None declared, Pia Isomäki Speakers bureau: AbbVie, Eli Lilly and Pfizer, Consultant of: AbbVie, Eli Lilly, Pfizer, Roche and ViforPharma, Grant/research support from: Pfizer, Kalle Aaltonen: None declared, Björn Gudbjornsson Speakers bureau: Novartis, not related to this work, Consultant of: Novartis, not related to this work, Thorvardur Love Speakers bureau: Celgene, Sella Aa. Provan: None declared, Brigitte Michelsen Grant/research support from: Novartis, not related to this work, Joe Sexton: None declared, Lene Dreyer Speakers bureau: Eli Lilly, Galderma and Janssen, Grant/research support from: BMS not related to this work, Karin Hellgren: None declared
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Cordtz R, Kristensen S, Westermann R, Duch K, Pearce F, Lindhardsen J, Torp-Pedersen C, Andersen MP, Dreyer L. OP0173 INCIDENCE OF COVID-19 INFECTION AND HOSPITALISATION ACCORDING TO VACCINATION STATUS AND DMARD TREATMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONWIDE MATCHED COHORT STUDY FROM DENMARK. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPatients with rheumatoid arthritis (RA) may have impaired immunogenicity to COVID-19 vaccines.ObjectivesTo investigate the incidence of COVID-19 infection and hospitalisation in unvaccinated and vaccinated patients with RA compared with matched individuals; and secondarily in patients with RA according to DMARD treatment.MethodsDanish nationwide matched cohort study from January to October 2021. Patients with RA were identified in DANBIO and matched 1:20 with individuals from the general population on age, sex, and vaccination status (month and exact type of vaccination). Primary and secondary outcomes were COVID-19 hospitalisation (Danish National Patient Register) and positive SARS-CoV2 PCR test (Danish COVID-19 Surveillance Register), respectively. Stratified by vaccination status, incidence rates (IRs) per 1000 person years (PY) and comorbidity-adjusted hazard ratios (aHRs) in cause-specific Cox models were calculated with 95% confidence intervals. Using the Aalen-Johansen estimator, the cumulative incidence of COVID-19 hospitalisations was visualised according to RA and vaccine exposure status.ResultsRegardless of vaccination status, patients with RA had increased incidence of COVID-19 hospitalisation compared to matched individuals (Table 1). However, the absolute risk was 0.20% for unvaccinated patients at 60 days and 0.08% for comparators, whereas it remained below 0.05% at 180 days of follow-up in both groups when fully vaccinated (Figure 1). Increased SARS-CoV2 infection rates were seen only among unvaccinated patients with RA (Table 1). Unadjusted analyses showed increased incidence of COVID-19 hospitalisation among rituximab-treated compared with conventional DMARD treated: unvaccinated HR 4.71 (1.98 to 11.18) and vaccinated HR 11.69 (2.07 to 66.06). However, the proportions of patients with previous cancer and treated with prednisolone were higher among the rituximab treated.Table 1.UnvaccinatedPartially vaccinatedFully vaccinatedRAControlsRAControlsRAControlsN28 447568 94027 154542 61026 217523 826Women, %71.371.371.271.271.071.0Age in years, median [IQR]67.7 [34.2 to 88.3]67.8 [34.2 to 88.4]68.4 [36.4 to 88.6]68.4 (36.5 to 88.6)68.9 [40.9 to 88.7]68.9 (41.0 to 88.7)Methotrexate /55.5 /0.5 /55.4 /1.2 /55.7 /1.3 /Sulfasalazine /14.2 /0.1 /13.7 /0.3 /13.5 /0.3 /Hydroxychloroquine /10.4 /0.1 /10.3 /0.0 /10.3 /0.0 /Other csDMARD,11.0 /0.2 /10.7 /0.3 /10.6 /0.3 /Prednisolone,all in %12.52.012.20.512.20.5TNFi /16.9 /0.1 /17.2 /2.9 /17.1 /3.1 /abatacept /1.5 /0.0 /1.5 /0.5 /1.5 /0.5 /tocilizumab /3.0 /0.0 /3.0 /0.0 /2.9 /0.0 /rituximab, all in %2.20.12.10.12.10.1COVID-19 hospitalisationN65727119511131Median [IQR] days of follow-up102 [62 to 137]115 [88 to 146]28 [22 to 35]30 (21 to 39)150 [111 to 189]150 (111 to 189)Rate per 1000 PY10.4 (8.0 to 13.4)4.7 (4.3 to 5.1)5.5 (3.0 to 10.0)2.2 (1.8 to 2.7)0.9 (0.5 to 1.6)0.5 (0.4 to 0.6)Adjusted HRa1.88 (1.44 to 2.46)1 (Ref.)2.47 (1.25 to 4.89)1 (Ref.)1.94 (1.03 to 3.66)1 (Ref.)SARS-CoV2 infectionRate per 1000 PY37.8 (33.6 to 42.6)33.9 (33.1 to 34.8)27 (20.7 to 35.1)28.5 (27 to 30.2)11.3 (9.2 to 13.9)10.4 (9.9 to 10.9)Adjusted HRa1.22 (1.09 to 1.57)1 (Ref.)0.87 (0.95 to 1.74)1 (Ref.)1.09 (0.92 to 1.14)1 (Ref.)IQR, Interquartile range. a Adjusted for cancer history, cardiovascular disease, diabetes mellitus, chronic kidney disease, and chronic lung disease.Figure 1.Cumulative incidence of COVID-19 hospitalisation (%) as a function of follow-up time (days) for (A) unvaccinated, (B) partially vaccinated and (C) fully vaccinated patients and comparators.ConclusionThe incidence of COVID-19 hospitalisation was increased for both unvaccinated and vaccinated patients with RA compared with controls. Importantly, the parallel decreasing risk for patients with RA suggests a comparable relative benefit of vaccination. Less favourable outcomes among rituximab-treated warrant that this drug should be considered with extra care.AcknowledgementsThe authors wish to acknowledge The Danish Departments of Clinical Microbiology and Statens Serum Institut for carrying out laboratory analysis, registration, and release of the national SARS-CoV-2 surveillance data use in the present study. Further, the authors wish to thank all the Danish departments of rheumatology for reporting to the DANBIO register.Disclosure of InterestsRené Cordtz: None declared, Salome Kristensen: None declared, Rasmus Westermann: None declared, Kirsten Duch: None declared, Fiona Pearce Grant/research support from: Pearce reports a grant from Vifor Pharma outside the submitted work., Jesper Lindhardsen: None declared, Christian Torp-Pedersen Grant/research support from: Torp-Pedersen reports grants from Bayer and Novo Nordisk outside the submitted work., Mikkel Porsborg Andersen: None declared, Lene Dreyer Speakers bureau: Dreyer has received speakers bureau from Eli Lilly and Galderma., Grant/research support from: Dreyer has received research grant/support from BMS.
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Cordtz R, Kristensen S, Westermann R, Duch K, Pearce F, Lindhardsen J, Torp-Pedersen C, Andersen MP, Dreyer L. COVID-19 infection and hospitalization risk according to vaccination status and DMARD treatment in patients with rheumatoid arthritis. Rheumatology (Oxford) 2022; 62:77-88. [PMID: 35416949 PMCID: PMC9047209 DOI: 10.1093/rheumatology/keac241] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The objectives of this study were to investigate the incidence of COVID-19 hospitalization in unvaccinated and vaccinated patients with RA compared with matched controls, and in patients with RA according to DMARD treatment. METHODS This was a Danish nationwide matched-cohort study from January to October 2021. Patients with RA were identified in the DANBIO register and matched 1:20 with individuals from the general population on age, sex, and vaccination status. Primary and secondary outcomes were COVID-19 hospitalization (Danish National Patient Register) and first-time positive SARS-CoV-2 PCR test (Danish COVID-19 Surveillance Register), respectively. Stratified by vaccination status, incidence rates (IRs) per 1000 person years (PYs) and comorbidity-adjusted hazard ratios (aHRs) in cause-specific Cox models were calculated with 95% confidence intervals. RESULTS In total, 28 447 unvaccinated patients and 568 940 comparators had IRs for COVID-19 hospitalization of 10.4 (8.0-13.4) and 4.7 (4.3-5.1) per 1000 PYs, respectively (aHR 1.88, 1.44-2.46). When fully vaccinated, corresponding IRs were 0.9 (0.5-1.6) and 0.5 (0.4-0.6) per 1000 PYs (aHR 1.94, 1.03-3.66). Unvaccinated RA patients had an aHR of 1.22 (1.09-1.57) for testing positive for SARS-CoV-2 and 1.09 (0.92-1.14) among vaccinated RA patients. Vaccinated rituximab-treated patients had increased crude IR of COVID-19 hospitalization compared with conventional DMARD-treated patients. CONCLUSION The incidence of COVID-19 hospitalization was increased for both unvaccinated and vaccinated patients with RA compared with controls. Importantly, the parallel decreasing risk for patients with RA suggests a comparable relative benefit of vaccination in most patients.
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Affiliation(s)
- René Cordtz
- Correspondence: Rene Cordtz, , Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000-Aalborg, Denmark
| | - Salome Kristensen
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rasmus Westermann
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Kirsten Duch
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark,Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Fiona Pearce
- Division of Epidemiology and Public Health, Department of Rheumatology, University of Nottingham, Nottingham, United Kingdom
| | - Jesper Lindhardsen
- Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark,DANBIO, Denmark
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Kristensen S, Cordtz R, Duch K, Lindhardsen J, Torp-Pedersen C, Dreyer L. Incidence and risk factors of COVID-19 in patients with vasculitis in the first year of the pandemic: a Danish nationwide cohort study. Clin Exp Rheumatol 2021; 40:856-857. [DOI: 10.55563/clinexprheumatol/elam3c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Salome Kristensen
- Department of Rheumatology, Aalborg University Hospital, Aalborg, and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - René Cordtz
- Department of Rheumatology, Aalborg University Hospital, Aalborg, and Department of Rheumatology, Centre for Rheumatology and Spine Diseases, Gentofte Hospital, Hellerup, Denmark
| | - Kirsten Duch
- Department of Rheumatology, Aalborg University Hospital, Aalborg, and Unit of Clinical Biostatistics, Aalborg University Hospital, Denmark
| | - Jesper Lindhardsen
- Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerod, and Department of Public Health, University of Copenhagen, Denmark
| | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Hellgren K, Ballegaard C, Delcoigne B, Cordtz R, Nordström D, Aaltonen K, Gudbjornsson B, Love TJ, Aarrestad Provan S, Sexton J, Zobbe K, Kristensen LE, Askling J, Dreyer L. Risk of solid cancers overall and by subtypes in patients with psoriatic arthritis treated with TNF inhibitors - a Nordic cohort study. Rheumatology (Oxford) 2021; 60:3656-3668. [PMID: 33401297 DOI: 10.1093/rheumatology/keaa828] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/07/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate whether TNF inhibitors (TNFi) are associated with increased risk of solid cancer in patients with psoriatic arthritis (PsA). METHODS From the Nordic clinical rheumatology registers (CRR) here: SRQ/ARTIS (Sweden), DANBIO (Denmark), NOR-DMARD (Norway), ROB-FIN (Finland) and ICEBIO (Iceland) we identified PsA patients who started a first TNFi 2001-2017 (n = 9655). We identified patients with PsA not treated with biologics from (i) the CRR (n = 14 809) and (ii) the national patient registers (PR, n = 31 350). By linkage to the national cancer registers, we collected information on incident solid cancer overall and for eight cancer types. We used Cox regression to estimate hazard ratio (HR) with 95% CI of cancer (per country and pooled) in TNFi-exposed vs biologics-naïve, adjusting for age, sex, calendar period, comorbidities and disease activity. We also assessed standardized incidence ratios (SIR) in TNFi-exposed PsA vs the general population (GP). RESULTS We identified 296 solid cancers among the TNFi-exposed PsA patients (55 850 person-years); the pooled adjusted HR for solid cancer overall was 1.0 (0.9-1.2) for TNFi-exposed vs biologics-naïve PsA from the CRR, and 0.8 (0.7-1.0) vs biologics-naïve PsA from the PRs. There were no significantly increased risks for any of the cancer types under study. The pooled SIR of solid cancer overall in TNFi treated PsA vs GP was 1.0 (0.9-1.1). CONCLUSION In this large cohort study from five Nordic countries, we found no increased risk of solid cancer in TNFi-treated PsA patients, neither for solid cancer overall nor for eight common cancer types.
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Affiliation(s)
- Karin Hellgren
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Rheumatology, Theme Inflammation & Infection, Karolinska University Hospital, Stockholm, Sweden
| | - Christine Ballegaard
- Bispebjerg and Frederiksberg, The Parker Institute, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Rheumatology and Spine Diseases, Rigshospitalet - Gentofte, Hellerup, Denmark
| | - Bénédicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - René Cordtz
- Bispebjerg and Frederiksberg, The Parker Institute, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Rheumatology and Spine Diseases, Rigshospitalet - Gentofte, Hellerup, Denmark
| | - Dan Nordström
- Department of Medicine and Rheumatology, ROB-FIN, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Kalle Aaltonen
- ROB-FIN, Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, Landspitali University Hospital, and Faculty of Medicine, Reykjavik, Iceland
| | - Thorvardur Jon Love
- Department of Science and Faculty of Medicine, National University Hospital of Iceland, University of Iceland, Reykjavik, Iceland
| | | | - Joe Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kristian Zobbe
- Bispebjerg and Frederiksberg, The Parker Institute, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Rheumatology and Spine Diseases, Rigshospitalet - Gentofte, Hellerup, Denmark
| | - Lars Erik Kristensen
- Bispebjerg and Frederiksberg, The Parker Institute, Copenhagen University Hospital, Hellerup, Denmark
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Rheumatology, Theme Inflammation & Infection, Karolinska University Hospital, Stockholm, Sweden
| | - Lene Dreyer
- Bispebjerg and Frederiksberg, The Parker Institute, Copenhagen University Hospital, Hellerup, Denmark.,Department of Rheumatology, Aalborg University Hospital, Aalborg University, Denmark.,DANBIO Registry, Denmark
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Hagelskjær A, Cordtz R, Bliddal S, Mortensen AS, Kristensen S, Nielsen CH, Feldt-Rasmussen U, Torp-Pedersen C, Dreyer L. POS0313 INCIDENCE AND PREVALENCE OF POLYAUTOIMMUNITY IN SEROPOSITIVE COMPARED WITH SERONEGATIVE PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONWIDE COHORT STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Rheumatoid arthritis (RA) is categorized as seropositive or seronegative referring to the presence or absence of IgM rheumatoid factor (IgM-RF) and/ or anti-citrullinated protein antibodies (ACPA).Patients with an autoimmune disease are more likely to develop additional autoimmune conditions than individuals without pre-existing autoimmune disease.Objectives:The aims of this study were to examine patterns of polyautoimmunity in seropositive compared with seronegative patients with recent-onset RA.Methods:The study was register-based and used the nationwide DANBIO register (identification of recent-onset (<1 year) seropositive, ICD-10 M05, and seronegative, M06, RA patients) linked to the Danish National Patient Registry and the Danish National Prescription Registry to obtain information on additional autoimmune diseases (see Table 1 for autoimmune conditions).Table 1.Characteristics, prevalence, and incidence of polyautoimmunity in incident RA patients.SeropositiveSeronegativeN79834534Age in years59.4 (48.6 to 69.1)63.0 (51.5 to 72.3)Women5476 (69 %)2856 (63 %)HAQ-DI0.857 (0.375 to 1.375)0.875 (0.375 to 1.375)DAS28-CRP4.3 (3.3 to 5.2)4.6 (3.6 to 5.5)CRP, mg/mL10 (4 to 23)10 (3 to 26)VAS physician, 0-100mm27 (15 to 45)30 (16 to 47)Treated with methotrexate86 %84 %-other csDMARD, %24 %24 %-Biological DMARD, %5 %6 %Smoking status:Current / previous / never / unknown, %13 / 11 / 17 / 59 %9 / 9 / 23 / 59 %Prevalence of polyautoimmunity / diabetes mellitus type 1 / autoimmune thyroid disease / inflammatory bowel disease549 (10.6 %) / 1.4 % / 6.7 % / 1.4 %349 (12.8 %) / 1.5 % / 7.8 % / 1.5 %Age and sex adjusted odds ratio0.79 (0.71 to 0.89)1 (ref.)Incident cases of polyautoimmunity373 (4.7 %)242 (5.3 %)Adjusted hazard ratio0.86 (0.71 to 1.05)1 (ref.)Continuous variables shown as median with interquartile ranges. Autoimmune conditions included:autoimmune thyroid disease (redeemed prescriptions of ATC=H03A); diabetes mellitus type 1 (ICD-10 diagnosis E10 combined with redeemed prescriptions of insulin, ATC=A10A); pernicious anaemia (D51.0); autoimmune haemolytic anaemia (D59.1); idiopathic thrombocytopenic purpura (D69.3); Autoimmune adrenalitis (E27.1B); multiple sclerosis (G35); neuromyelitis optica (G36.0); Guillain-Barré syndrome (G61.0); myasthenia gravis (G70); inflammatory bowel disease (K50-1); primary biliary cirrhosis (K74.3); primary sclerosing cholangitis (K83.0); autoimmune hepatitis (K75.4); celiac disease (K90.0); pemphigus vulgaris (L10.0); bullous pemphigoid (L12.0); dermatitis herpetiformis (L13.0); alopecia areata (L63); vitiligo (L80); lichen sclerosis (L90.0); chronic interstitial cystitis (N30.1).Using age and sex adjusted logistic regression analysis, the odds ratio (OR) of prevalent polyautoimmunity in seropositive compared with seronegative patients at the time of RA diagnosis was calculated.To estimate the hazard ratio (HR) for developing yet another autoimmune disease in the 5 years after RA diagnosis, adjusted cause-specific Cox regression models were performed. Several sensitivity analyses were carried out including alternative exposure and outcome definitions.Results:In total, 12,517 patients with recent-onset RA were included. The groups were similar in terms of disease characteristics and DMARD treatment, but seropositive patients were younger and included more women, see Table 1. Patients with seropositive RA had an OR of 0.79 (95% CI 0.71-0.89) for baseline presence of polyautoimmunity compared with seronegative patients, whereas the 5-year HR was 0.86 (95% CI 0.71-1.05) for incident polyautoimmunity. The results remained similar in all sensitivity analyses.Conclusion:Patients with seropositive RA had a slightly lower prevalence and incidence of polyautoimmunity compared to seropositive patients. The results were somewhat surprising, yet very robust, and thus raises the question if seronegative RA is in fact “more autoimmune” despite the absence of (identified) autoantibodies.Acknowledgements:We acknowledge all patients and all Danish departments of rheumatology contributing to the DANBIO registry.Disclosure of Interests:Amalie Hagelskjær: None declared, René Cordtz: None declared, Sofie Bliddal: None declared, Anders Sandermann Mortensen: None declared, Salome Kristensen: None declared, Claus Henrik Nielsen: None declared, Ulla Feldt-Rasmussen: None declared, Christian Torp-Pedersen: None declared, Lene Dreyer Grant/research support from: Grants from BMS, Galderma, and Eli Lilly
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Westermann R, Zobbe K, Cordtz R, Haugaard JH, Dreyer L. Increased cancer risk in patients with cutaneous lupus erythematosus and systemic lupus erythematosus compared with the general population: A Danish nationwide cohort study. Lupus 2021; 30:752-761. [PMID: 33497306 DOI: 10.1177/0961203321990106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate if patients with cutaneous lupus erythematosus (CLE) or systemic lupus erythematosus (SLE) have an increased risk of cancer compared with the general population, and furthermore to identify specific cancer types associated with increased risk. METHODS This is an observational cohort study of 5310 patients with CLE or SLE identified in the Danish National Patient Register from 1 January 1995 to 31 December 2014. The cohort was followed up for cancer by linkage to the Danish Cancer Registry. Based on the age, sex, and calendar specific cancer rates of the general population of Denmark, standardised incidence ratios (SIRs) were calculated. RESULTS The patients with CLE or SLE were followed for 40.724 person-years, each group's average duration of follow-up being 6.9 and 8.1 years. The SIR for overall cancer (except non-melanoma skin cancer (NMSC)) was increased in patients with CLE 1.35 (95%CI 1.15 to 1.58) and patients with SLE 1.45 (95%CI 1.30 to 1.62). Both groups had high risks of hematological - including a 3-4-fold increased risk of non-Hodgkin lymphoma -, pancreatic, and lung cancers. Several cancers associated with oncogenic viruses as liver and tongue/mouth/pharynx were increased in the SLE group, while the risk of ovarian cancer was increased 2-4-fold only in the CLE group. CONCLUSION The overall risk of cancer was significantly increased in both patients with CLE and SLE. SIRs for hematological, pancreatic and lung cancers were elevated in both groups. Extra awareness of cancer in patients with SLE and patients with CLE should be considered.
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Affiliation(s)
- Rasmus Westermann
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Zobbe
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Center for Rheumatology and Spine diseases, Rigshospitalet Gentofte, Copenhagen, Denmark
| | - René Cordtz
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Jeanette H Haugaard
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Lene Dreyer
- Department of Dermatology, Allergy and Venerology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
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Cordtz R, Lindhardsen J, Soussi BG, Vela J, Uhrenholt L, Westermann R, Kristensen S, Nielsen H, Torp-Pedersen C, Dreyer L. Incidence and severeness of COVID-19 hospitalisation in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark. Rheumatology (Oxford) 2020; 60:SI59-SI67. [PMID: 33369663 PMCID: PMC7798558 DOI: 10.1093/rheumatology/keaa897] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives To estimate the incidence of COVID-19 hospitalisation in patients with inflammatory rheumatic disease (IRD); in patients with rheumatoid arthritis (RA) treated with specific DMARDs; and the incidence of severe COVID-19 infection among hospitalised patients with RA. Methods A nationwide cohort study from Denmark between 1 March to 12 August 2020. The adjusted incidence of COVID-19 hospitalisation was estimated for patients with RA; spondyloarthritis including psoriatic arthritis; connective tissue disease; vasculitides; and non-IRD individuals.Further, the incidence of COVID-19 hospitalisation was estimated for patients with RA treated respectively non-treated with TNF-inhibitors, hydroxychloroquine, or glucocorticoids.Lastly, the incidence of severe COVID-19 infection (intensive care, acute respiratory distress syndrome, or death) among hospital-admitted patients was estimated for RA and non-IRD individudals. Results Patients with IRD (n = 58,052) had an increased partially adjusted incidence of hospitalisation with COVID-19 compared with the 4.5 million people in the general population (HR 1.46, 95%CI 1.15 to 1.86) with strongest associations for patients with RA (n = 29,440, HR 1.72, 95%CI 1.29 to 2.30) and vasculitides (n = 4072, HR 1.82, 95%CI 0.91 to 3.64). There was no increased incidence of COVID-19 hospitalisation associated with TNF-inhibitor, hydroxychloroquine nor glucocorticoid use. COVID-19 admitted patients with RA had a HR of 1.43 (95% CI 0.80 to 2.53) for a severe outcome. Conclusion Patients with IRD were more likely to be admitted with COVID-19 than the general population, and COVID-19 admitted patients with RA could be at higher risk of a severe outcome. Treatment with specific DMARDs did not affect the risk of hospitalisation.
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Affiliation(s)
- René Cordtz
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Rheumatology, Center for Rheumatology and Spine Diseases, Gentofte Hospital, Hellerup, Denmark
| | - Jesper Lindhardsen
- Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Bolette G Soussi
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Jonathan Vela
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Line Uhrenholt
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Rasmus Westermann
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Salome Kristensen
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Nielsen
- Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.,Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.,The DANBIO Register, Denmark
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Chatzidionysiou K, Delcoigne B, Frisell T, Hetland ML, Glintborg B, Dreyer L, Cordtz R, Zobbe K, Nordström D, Trokovic N, Aaltonen K, Provan SA, Grondal G, Gudbjornsson B, Askling J. How do we use biologics in rheumatoid arthritis patients with a history of malignancy? An assessment of treatment patterns using Scandinavian registers. RMD Open 2020; 6:rmdopen-2020-001363. [PMID: 32900882 PMCID: PMC7510630 DOI: 10.1136/rmdopen-2020-001363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Katerina Chatzidionysiou
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska Institutet Department of Medicine Solna, Stockholm, Sweden
| | - Bénédicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska Institutet Department of Medicine Solna, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska Institutet Department of Medicine Solna, Stockholm, Sweden
| | - Merete L Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg Universitet, Aalborg, Denmark
| | - René Cordtz
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Gentofte Hospital, The Parker Institute, Frederiksberg Hospital Parker Institute, Frederiksberg, Denmark
| | - Kristian Zobbe
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Gentofte Hospital, The Parker Institute, Frederiksberg Hospital Parker Institute, Frederiksberg, Denmark
| | - Dan Nordström
- Helsinki University and Hospital (ROB-FIN), Departments of Medicine and Rheumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Nina Trokovic
- Helsinki University and Hospital (ROB-FIN), Departments of Medicine and Rheumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Kalle Aaltonen
- Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | | | - Gerdur Grondal
- Department of Rheumatology and Centre for Rheumatology Research, National University Hospital of Iceland, Reykjavik, Iceland
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, University Hospital, and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska Institutet Department of Medicine Solna, Stockholm, Sweden
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Helene Ibfelt E, Kart Jacobsen R, Kopp TI, Cordtz R, Svarre Jakobsen A, Seersholm N, Burhan Shaker S, Dreyer L. OP0232 TREATMENT WITH METHOTREXATE AND RISK OF LUNG DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONWIDE POPULATION-BASED COHORT STUDY FROM DENMARK. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Methotrexate (MTX) is the recommended first-line drug in EULAR and ACR treatment guidelines for rheumatoid arthritis (RA) and hence the most commonly prescribed DMARD in the treatment of this group of patients. However, lung disease is considered a potential adverse effect of MTX treatment.Objectives:To investigate the risk of interstitial lung disease (ILD) and acute and chronic respiratory failure in RA patients treated with MTX and other medications.Methods:From the Danish National Patient Register (DNPR) and the clinical DANBIO Register for rheumatic diseases, we retrieved data on RA patients registered between 1997 and 2015. Information on ILD and respiratory failure outcomes was obtained from DNPR, and information on redeemed prescriptions for MTX and other medications was obtained through linkage to the Danish Prescription Register. Associations between MTX and lung disease outcomes were analyzed in Cox regression models adjusted for age, calendar time, sex and use of other medications possessing the potential for pulmonary toxicity. Standardized Incidence Ratios (SIRs) of lung disease were calculated to compare RA patients to the general population.Results:Of the 30,512 RA patients identified, 60% patients had redeemed at least one prescription for MTX, 35% had redeemed a prescription for sulphasalazine, 6% had redeemed a prescription of either amiodarone or nitrofurantoin, and 27% had not received any of the included drugs at the end of the 5-year follow-up for ILD and respiratory failure. MTX treatment was not associated with an increased risk of lung disease (≥1 redeemed prescription(s) compared to no prescriptions), HR 1.00 (95% CI 0.78 to 1.27) for ILD and 0.54 (95%CI 0.43 to 0.67) for respiratory failure at 5-year follow-up (Table). The SIR was 3-4 times increased for ILD in MTX-treated RA patients, but this was no different from the RA population in general compared to the background population.Table.Hazard ratios (HR) with 95% confidence intervals (95%CI) for the risk of interstitial lung disease (ILD) and acute or chronic respiratory failure in 30,512 patients with rheumatoid arthritis up to 5 years after diagnosis.ILD (incl. drug-induced cases)1 year of follow up5 years of follow upEvents, NHR (95% CI)Events, NHR (95% CI)Methotrexate, ≥1 redeemed prescription(s) vs. none621.03 (0.71 to 1.48)1661.00 (0.78 to 1.27)Sulphasalazine, ≥1 redeemed prescription(s) vs. none210.88 (0.54 to 1.43)901.14 (0.89 to 1.48)Amiodarone and/or nitrofurantoin, ≥1 redeemed prescription(s) vs. none10.57 (0.08 to 4.10)70.65 (0.31 to 1.38Women72Ref.155Ref.Men551.51 (1.06 to 2.16)1301.74 (1.38 to 2.21)Acute or chronic respiratory failure1-year of follow up5-years of follow upEvents, NHR (95% CI)Events, NHR (95% CI)Methotrexate, ≥1 redeemed prescription(s) vs. none360.48 (0.32 to 0.73)1580.54 (0.43 to 0.67)Sulphasalazine, ≥1 redeemed prescription(s) vs. none140.70 (0.39 to 1.26)991.09 (0.86 to 1.38)Amiodarone and/or nitrofurantoin, ≥1 redeemed prescription(s) vs. none63.01 (1.31 to 6.94)221.33 (0.86 to 2.06)Women71Ref.239Ref.Men381.07 (0.72 to 1.59)1201.04 (0.83 to 1.29)Conclusion:RA patients had an increased risk of ILD compared to the general population, but that risk was not further increased in patients treated with MTX compared to non-MTX treated.Disclosure of Interests:None declared
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Vela J, Cordtz R, Kristensen S, Kjær Petersen K, Arent-Nielsen L, Torp-Pedersen CT, Dreyer L. THU0473 IS PAIN INTENSITY ASSOCIATED WITH EARLY MORTALITY IN PATIENTS WITH PSORIATIC ARTHRITIS? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Studies regarding excess mortality among patients with psoriatic arthritis (PsA) are conflicting due to the heterogenous nature of the disease. Thus, identifying risk factors for mortality is crucial, but few studies have examined these in PsA. Presence of chronic pain can cause excess mortality and since pain is prevalent among patients with PsA this association should be explored.Objectives:To investigate whether higher cumulative pain intensity is associated with an excess mortality ratio in patients with PsA.Methods:A nested case-control study was performed using data from the national Danish healthcare registers and the DANBIO rheumatology register. Cases were patients who died while followed in routine care. Cases were matched on sex, year of birth and calendar period of DANBIO entry with up to five controls. The main exposure of interest was the mean pain intensity (all causes) reported during the time followed in routine rheumatology practice. The pain intensity was measured on a visual analogue scale (VAS) ranging from 0 (no pain) to 100 (worst imaginable pain). Conditional logistic regression was used to calculate the odds of mortality per 5 unit increase in VAS pain while adjusting for inflammatory markers.Results:The Danbio PsA cohort consisted of 8019 patients. In total, 266 cases, i.e. PsA patients who died during the observational period, were identified and matched with 1198 controls (4.5 controls per case). Increasing pain intensity was associated with increased odds of mortality (OR 1.05, 95%CI 1.01 to 1.09) in the crude model, but the association disappeared when adjusting for age, sex, calendar time, socioeconomic status, average c-reactive protein and swollen joint count during the observation period (OR 0.98, 95%CI 0.93-1.03).Age, average CRP, biological DMARD use, glucocorticoid use, and comorbidities (see table) increased the odds of mortality.Tableregression estimates from fully adjusted modelOdds Ratio95% CIAge2,731,60-4,68C-reactive protein1,051,03-1,07Swollen joint count1,080,97-1,22Health assessment questionnaire1,250,84-1,86bDMARD use2,621,51-4,57cDMARD use0,690,46-1,03Glucocorticoid use3,902,51-6,05Chronic obstructive pulmonary disease2,191,20-4,02Diabetes mellitus2,651,62-4,31Cancer6,153,88-9,76Cardiovascular disease2,611,71-3,97Conclusion:These results indicate that experienced pain in itself is not associated with excess mortality. Age, recent glucocorticoid use, biological DMARD use, chronic pulmonary disease, diabetes, cancer and cardiovascular disease were all associated with an increased mortality.Disclosure of Interests: :None declared
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Westermann R, Zobbe K, Cordtz R, Dreyer L. THU0288 CANCER RISK IN PATIENTS WITH CUTANEOUS LUPUS ERYTHEMATOSUS AND SYSTEMIC LUPUS ERYTHEMATOSUS COMPARED TO THE GENERAL POPULATION: A DANISH NATIONWIDE COHORT STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Research suggesting an elevated risk of cancer among patients with Systemic Lupus Erythematosus (SLE) has increased in recent years. Yet, the size of the overall cancer risk and the risk of respective cancer sites varies. Research examining the cancer risk of Cutaneous Lupus Erythematosus (CLE) patients remains limited. Therefore, in order to further guide and monitor patients with SLE and CLE, additional research estimating the risk of cancer is needed.Objectives:To determine if patients with SLE or CLE have an increased risk of cancer compared to the general population, and furthermore to identify specific cancer types associated with increased risk.Methods:This was an observational cohort study of 3424 SLE and 1886 CLE patients identified in The Danish National Patient Register (DNPR) from 1stJanuary 1995 to 31stDecember 2014. The cohorts were followed up for cancer by linkage to The Danish Cancer Registry (DCR). Based on the age, sex, and calendar specific cancer rates from Denmark, standardized incidence ratios (SIRs) were calculated for the SLE and CLE groups, respectively.Results:The SLE and CLE cohorts were followed for 27,676 and 13,048 person years, each group’s average duration of follow-up being 8.1 and 6.9 years, respectively. Compared to the general population, the SIRs for the overall cancer (except non-melanoma skin cancer) risk was 1.45 (95%CI 1.30 to 1.62) in the SLE group and 1.35 (95%CI 1.15 to 1.58) in the CLE group. Both CLE and SLE patients had increased risks of hematological, pancreas and lung cancers. Liver, tongue/mouth/pharynx, non-melanoma skin cancer, oesophagus and meninges cancers were only increased in the SLE group.Table 1.SIR for overall cancer in Danish SLE patients according to gender, time since diagnosis and ageOverall cancer except NMSCObserved no. cancersExpected no. cancersPYRSSIR (95% CI)All308212.027,6761.45 (1.30 to 1.62)Female246170.023,9251.45 (1.27 to 1.64)Male6242.037511.48 (1.13 to 1.89)Time since SLE diagnosis< 1 year5220.332132.56 (1.91 to 3.36)1 to 4 years10370.310,2701.47 (1.20 to 1.78)4 to 9 years8364.481631.29 (1.03 to 1.60)10+ years7057.060301.23 (0.96 to 1.55)Age at SLE diagnosis< 40 years119.072011.23 (0.61 to 2.20)40 to 60 years9467.012,3091.41 (1.14 to 1.73)60+ years203137.081661.49 (1.29 to 1.71)SLE = Systemic lupus erythematosus, NMSC = Non-melanoma skin cancer, PYRS = Person years, SIR = Standardized Incidence Ratio, CI = Confidence IntervalTable 2.SIR for overall cancer in Danish CLE patients according to gender, time since diagnosis and ageOverall cancer except NMSCObserved no. cancersExpected no. cancersPYRSSIR (95% CI)All155114.713,0481.35 (1.15 to 1.58)Female11987.510,0921.36 (1.13 to 1.63)Male3627.229561.32 (0.93 to 1.83)Time since CLE diagnosis< 1 year2912.816812.26 (1.51 to 3.24)1 to 4 years5340.249551.32 (0.99 to 1.72)4 to 9 years4134.237971.20 (0.86 to 1.63)10+ years3227.426151.17 (0.80 to 1.65)Age at CLE diagnosis< 40 years62.923692.04 (0.75 to 4.43)40 to 60 years4931.459621.56 (1.15 to 2.06)60+ years10080.347171.24 (1.01 to 1.51)CLE = Cutaneous lupus erythematosus, NMSC = Non-melanoma skin cancer, PYRS = Person years, SIR = Standardized Incidence Ratio, CI = Confidence IntervalGraphsSLE cancer sites: Standardized incidence ratios and corresponding 95% confidence intervalsCLE cancer sites: Standardized incidence ratios and corresponding 95% confidence intervalsConclusion:The risk of overall cancer was significantly increased in patients with SLE and CLE. Hematological, pancreas and lung cancers were elevated in both groups, while certain virus-associated cancers and other sites were increased only among SLE patients. Awareness of cancer in patients with SLE and CLE should be considered, especially of symptoms from high-risk sites.Disclosure of Interests:None declared
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Lund I, Hansen A, Stampe B, Cordtz R, Dreyer L. SAT0632-HPR PATIENTS VIEW ON CONSULTATION IN OUTPATIENT CLINIC – FROM SATISFACTION TO DEMAND OF GUIDANCE INTO MORE SELF-MANAGEMENT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patients with rheumatic diseases, routinely consult the outpatient clinic 1-2 times a year to see their rheumatologist. Many of the patients also attend nurse-led consultations to receive instructions, regarding treatment in association to their intravenous treatment, or DMARD dispensing in the clinic. As clinicians we have an assumption of what the ”good practice” is in relation to the patients, but we have little insight, into the patients’ own experience and satisfaction.Objectives:To investigate the patients views on the level of information, and their experience and satisfaction with the doctor and nurse-led consultations in the outpatient clinic.Methods:The approach of the survey was both quantitative and qualitative. A questionnaire was designed with four questions on a matrix scale concerningtheir information level on their disease/symptoms;their treatment;if they had received written material and if so, it’s value; andtheir possibility to talk about subjects that matters for them during consultations. To gain a qualitative approach with focus on the patients’ experiences and comments, every question was constructed with space for comments. Comments were transcribed, indexed, analysed, and thematically divided. The inclusion of patients were all patients visiting the clinic within a specific week in January 2019.Results:The results from the four questions, are shown in the figures below, measured in percentage. In total, 283 participated (response rate 60%).Four themes covered from the analysis of patients’ comments.“Seeking own answers”, “Own coping – effort”, “Conversation with doctor/nurse”and“Treatment/medication”.Comments revealed many descriptions and stories of patients, showered with all types of suggestions of taking control or managing the disease by them self, from their family or media. It also revealed their interest in discussing, these subjects and matters with the doctor/nurse, without being rejected. The feeling of rejection resulted in some patients trying other treatments or introducing changes in their lifestyle, without involving the doctor. The patients also called for more knowledge about physical training, and not only medical treatment.Conclusion:In general, the patients had a very positive perception towards the consultations, and the information from the outpatient clinic. Despite that, the themes indicated a pattern, that needs to be considered, so clinicians acknowledge the patients wish for guidance, besides the medical treatment. To support the patient, without leaving them with a feeling of being rejected, we need to consider how to articulate the subjects the patients are exposed to outside our clinic, so the patients feel free to inform or involve the clinic instead of being silent, in risk of counteracting the medical treatment.Acknowledgments:We are grateful to the participants who shared their experiences. We also thank an internal research group taking part of the investigation.Disclosure of Interests:Ida Lund: None declared, Annette Hansen Consultant of: AbbVie, Speakers bureau: Eli Lily, Betina Stampe: None declared, René Cordtz: None declared, Lene Dreyer: None declared
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Cordtz R, Hawley S, Prieto-Alhambra D, Højgaard P, Zobbe K, Kristensen LE, Overgaard S, Odgaard A, Soussi BG, Dreyer L. Reduction in Upper Limb Joint Surgery Among Rheumatoid Arthritis Patients: An Interrupted Time-Series Analysis Using Danish Health Care Registers. Arthritis Care Res (Hoboken) 2020; 72:274-282. [PMID: 30680930 DOI: 10.1002/acr.23835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/15/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Joint replacement surgery is a proxy of severe joint damage in rheumatoid arthritis (RA). The aim of this study was to assess the impact of the introduction of biologic disease-modifying antirheumatic drugs (bDMARDs) on the incidence rate (IR) of upper limb joint replacements among newly diagnosed RA patients. METHODS Using the Danish National Patient Register, patients with incident RA from 1996-2012 were identified. Each patient was matched on age, sex, and municipality, with up to 10 general population controls. The age- and sex-standardized 5-year IR per 1,000 person-years of a composite outcome of any first joint replacement of the finger, wrist, elbow, or shoulder was calculated, and an interrupted time-series analysis was undertaken to investigate trends and changes of the IR in the pre-bDMARD (1996-2001) and the bDMARD eras (2003-2012), with a 1-year lag period in 2002. RESULTS In total, 18,654 incident patients with RA were identified (mean age 57.6 years, 70.5% women). The IR of joint replacements among patients with RA was stable at 2.46 per 1,000 person-years (95% confidence interval [95% CI] 1.96, 2.96) from 1996 to 2001 but started to decrease from 2003 onwards (-0.08 per 1,000 person-years annually [95% CI -0.20, 0.02]). Compared with patients with RA, the IR among controls in 1996 was 1/17 and increased continuously throughout the study period. CONCLUSION The IR of upper limb joint replacements started to decrease among patients with RA from 2002 onwards, whereas it increased among controls. Our results suggest an association between the introduction of bDMARDs and a lower need of joint replacements among patients with RA.
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Affiliation(s)
- René Cordtz
- Rigshospitalet-Gentofte, Copenhagen, Denmark, The Parker Institute, Bispebjerg, Denmark, and Frederiksberg Hospital, Frederiksberg, Denmark
| | | | - Daniel Prieto-Alhambra
- University of Oxford, Oxford, UK, and Idiap Jordi Gol, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, Universitat Autònoma de Barcelona, and Instituto de Salud Carlos III, Barcelona, Spain
| | - Pil Højgaard
- Rigshospitalet-Gentofte, Copenhagen, Denmark, The Parker Institute, Bispebjerg, Denmark, and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Kristian Zobbe
- Rigshospitalet-Gentofte, Copenhagen, Denmark, The Parker Institute, Bispebjerg, Denmark, and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg, Denmark, and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Søren Overgaard
- Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Anders Odgaard
- Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | | | - Lene Dreyer
- Aalborg University and Aalborg University Hospital, Aalborg, Denmark, Rigshospitalet-Gentofte, Copenhagen, Denmark, The Parker Institute, Bispebjerg, Denmark, and Frederiksberg Hospital, Frederiksberg, Denmark
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Hawley S, Ali MS, Cordtz R, Dreyer L, Edwards CJ, Arden NK, Cooper C, Judge A, Hyrich K, Prieto-Alhambra D. Impact of TNF inhibitor therapy on joint replacement rates in rheumatoid arthritis: a matched cohort analysis of BSRBR-RA UK registry data. Rheumatology (Oxford) 2019; 58:1168-1175. [PMID: 30649521 PMCID: PMC6587915 DOI: 10.1093/rheumatology/key424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/03/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Previous ecological data suggest a decline in the need for joint replacements in RA patients following the introduction of TNF inhibitor (TNFi) therapy, although patient-level data are lacking. Our primary aim was to estimate the association between TNFi use and subsequent incidence of total hip replacement (THR) and total knee replacement. METHODS A propensity score matched cohort was analysed using the British Society for Rheumatology Biologics Registry (2001-2016) for RA data. Propensity score estimates were used to match TNFi users to similar conventional synthetic DMARD users (with replacement) using a 1:1 ratio. Weighted multivariable Cox regression was used to estimate the impact of TNFi on study outcomes. Effect modification by baseline age and disease severity were investigated. Joint replacement at other sites was also analysed. An instrumental variable sensitivity analysis was also performed. RESULTS The matched analysis contained a total of 19 116 patient records. Overall, there was no significant association between TNFi use vs conventional synthetic DMARD on rates of THR (hazard ratios = 0.86 [95% CI: 0.60, 1.22]) although there was significant effect modification by age (P < 0.001). TNFi was associated with a reduction in THR among those >60 years old (hazard ratio = 0.60 [CI: 0.41, 0.87]) but not in younger patients. No significant associations were found for total knee replacement or other joint replacement. CONCLUSION Overall, no association was found between the use of TNFi and subsequent incidence of joint replacement. However, TNFi was associated with a 40% relative reduction in THR rates among older patients.
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Affiliation(s)
- Samuel Hawley
- Pharmaco- and Device-Epidemiology Group, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford
| | - M Sanni Ali
- Pharmaco- and Device-Epidemiology Group, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - René Cordtz
- Centre for Rheumatology and Spine Diseases, Gentofte, Rigshospitalet
- The Parker Institute, Copenhagen University Hospital Copenhagen
| | - Lene Dreyer
- Department of Rheumatology and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton
| | - Andrew Judge
- Pharmaco- and Device-Epidemiology Group, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton
- Translational Health Sciences, University of Bristol, Bristol
| | - Kimme Hyrich
- NIHR Manchester Biomedical Research Centre, NHS Foundation Trust, Manchester University, Manchester, UK
- Division of Musculoskeletal & Dermatological Sciences, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Daniel Prieto-Alhambra
- Pharmaco- and Device-Epidemiology Group, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford
- GREMPAL Research Group, Idiap Jordi Gol and CIBERFes, Unviersitat Autonoma de Barcelona and Insituto de Salud Carlos III, Barcelona, Spain
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Zobbe K, Prieto-Alhambra D, Cordtz R, Højgaard P, Hindrup JS, Kristensen LE, Dreyer L. Secular trends in the incidence and prevalence of gout in Denmark from 1995 to 2015: a nationwide register-based study. Rheumatology (Oxford) 2018; 58:836-839. [DOI: 10.1093/rheumatology/key390] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/09/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To investigate temporal trends in the incidence and prevalence of gout in the adult Danish population.
Methods
Using the nationwide Danish National Patient Registry, we calculated the number of incident gout patients (per 100 000 person-years) within each 1 year period from 1995 to 2015 and the prevalence of gout in 2000 and 2015. Further, we calculated age- and gender-specific incidence rates of gout from 1995 to 2015.
Results
We identified a total of 45 685 incident gout patients (72.9% males) with a mean age of 65 years (s.d. 16) at diagnosis. In both genders, an increase in age-standardized incidence rates was observed from 32.3/100 000 (95% CI 30.7, 33.9) in 1995 to 57.5/100 000 (95% CI 55.6, 59.5) in 2015 (P < 0.001). Similar trends were observed for 8950 cases diagnosed in rheumatology departments. We likewise observed an increase in the prevalence of gout from 0.29% (95% CI 0.29, 0.30) in 2000 to 0.68% (95% CI 0.68, 0.69) in 2015.
Conclusions
The annual incidence rate of gout increased by almost 80% in Denmark between 1995 and 2015. The prevalence increased by nearly 130% between 2000 and 2015. Reasons for this are unknown but may include an increase in risk factors (e.g. obesity, diabetes mellitus), longer life expectancy and increased awareness of the disease among patients and/or health professionals.
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Affiliation(s)
- Kristian Zobbe
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Gentofte University Hospital, Hellerup
- Bispebjerg and Frederiksberg Hospital, Parker Institute, Frederiksberg, Denmark
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Idiap Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - René Cordtz
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Gentofte University Hospital, Hellerup
- Bispebjerg and Frederiksberg Hospital, Parker Institute, Frederiksberg, Denmark
| | - Pil Højgaard
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Gentofte University Hospital, Hellerup
- Bispebjerg and Frederiksberg Hospital, Parker Institute, Frederiksberg, Denmark
| | - Jens Skøt Hindrup
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Gentofte University Hospital, Hellerup
| | | | - Lene Dreyer
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Gentofte University Hospital, Hellerup
- Bispebjerg and Frederiksberg Hospital, Parker Institute, Frederiksberg, Denmark
- Department of Rheumatology, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Højgaard P, Ballegaard C, Cordtz R, Zobbe K, Clausen M, Glintborg B, Kristensen LE, Dreyer L. Gender differences in biologic treatment outcomes—a study of 1750 patients with psoriatic arthritis using Danish Health Care Registers. Rheumatology (Oxford) 2018; 57:1651-1660. [DOI: 10.1093/rheumatology/key140] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Indexed: 01/16/2023] Open
Affiliation(s)
- Pil Højgaard
- Rigshospitalet Gentofte, Center for Rheumatology and Spine Diseases, Aalborg University Hospital, Denmark
- Frederiksberg and Bispebjerg Hospitals, The Parker Institute, Aalborg University Hospital, Denmark
| | - Christine Ballegaard
- Rigshospitalet Gentofte, Center for Rheumatology and Spine Diseases, Aalborg University Hospital, Denmark
- Frederiksberg and Bispebjerg Hospitals, The Parker Institute, Aalborg University Hospital, Denmark
| | - René Cordtz
- Rigshospitalet Gentofte, Center for Rheumatology and Spine Diseases, Aalborg University Hospital, Denmark
- Frederiksberg and Bispebjerg Hospitals, The Parker Institute, Aalborg University Hospital, Denmark
| | - Kristian Zobbe
- Rigshospitalet Gentofte, Center for Rheumatology and Spine Diseases, Aalborg University Hospital, Denmark
- Frederiksberg and Bispebjerg Hospitals, The Parker Institute, Aalborg University Hospital, Denmark
| | - Marianne Clausen
- Rigshospitalet Gentofte, Center for Rheumatology and Spine Diseases, Aalborg University Hospital, Denmark
| | - Bente Glintborg
- Rigshospitalet Gentofte, Center for Rheumatology and Spine Diseases, Aalborg University Hospital, Denmark
- Rigshospitalet Glostrup, The DANBIO registry, Copenhagen Center for Arthritis Research, Aalborg University Hospital, Denmark
| | - Lars Erik Kristensen
- Frederiksberg and Bispebjerg Hospitals, The Parker Institute, Aalborg University Hospital, Denmark
| | - Lene Dreyer
- Rigshospitalet Gentofte, Center for Rheumatology and Spine Diseases, Aalborg University Hospital, Denmark
- Frederiksberg and Bispebjerg Hospitals, The Parker Institute, Aalborg University Hospital, Denmark
- Department of Rheumatology, Aalborg University Hospital, Denmark
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Ballegaard C, Højgaard P, Dreyer L, Cordtz R, Jørgensen TS, Skougaard M, Tarp S, Kristensen LE. Impact of Comorbidities on Tumor Necrosis Factor Inhibitor Therapy in Psoriatic Arthritis: A Population-Based Cohort Study. Arthritis Care Res (Hoboken) 2018; 70:592-599. [DOI: 10.1002/acr.23333] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 07/25/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Christine Ballegaard
- The Parker Institute and Copenhagen University Hospital; Bispebjerg and Frederiksberg Hospital; and Gentofte Hospital; Hellerup Denmark
| | - Pil Højgaard
- The Parker Institute and Copenhagen University Hospital; Bispebjerg and Frederiksberg Hospital; and Gentofte Hospital; Hellerup Denmark
| | - Lene Dreyer
- The Parker Institute and Copenhagen University Hospital; Bispebjerg and Frederiksberg Hospital; and Gentofte Hospital, Hellerup; and DANBIO Registry and Rigshospitalet; Glostrup Denmark
| | - René Cordtz
- The Parker Institute and Copenhagen University Hospital; Bispebjerg and Frederiksberg Hospital; and Gentofte Hospital; Hellerup Denmark
| | - Tanja Schjødt Jørgensen
- The Parker Institute and Copenhagen University Hospital and Bispebjerg and Frederiksberg Hospital; Hellerup Denmark
| | - Marie Skougaard
- The Parker Institute and Copenhagen University Hospital and Bispebjerg and Frederiksberg Hospital; Hellerup Denmark
| | - Simon Tarp
- The Parker Institute and Copenhagen University Hospital and Bispebjerg and Frederiksberg Hospital; Hellerup Denmark
| | - Lars Erik Kristensen
- The Parker Institute and Copenhagen University Hospital and Bispebjerg and Frederiksberg Hospital; Hellerup Denmark
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Hawley S, Cordtz R, Dreyer L, Edwards CJ, Arden NK, Delmestri A, Silman A, Cooper C, Judge A, Prieto-Alhambra D. Association between NICE guidance on biologic therapies with rates of hip and knee replacement among rheumatoid arthritis patients in England and Wales: An interrupted time-series analysis. Semin Arthritis Rheum 2017; 47:605-610. [PMID: 29055489 DOI: 10.1016/j.semarthrit.2017.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/18/2017] [Accepted: 09/20/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the impact of NICE approval of tumor necrosis factor inhibitor (TNFi) therapies on the incidence of total hip replacement (THR) and total knee replacement (TKR) among rheumatoid arthritis (RA) patients in England and Wales. METHODS Primary care data [Clinical Practice Research Datalink (CPRD)] for the study period (1995-2014) were used to identify incident adult RA patients. The age and sex-standardised 5-year incidence of THR and TKR was calculated separately for RA patients diagnosed in each six-months between 1995-2009. We took a natural experimental approach, using segmented linear regression to estimate changes in level and trend following the publication of NICE TA 36 in March 2002, incorporating a 1-year lag. Regression coefficients were used to calculate average change in rates, adjusted for prior level and trend. RESULTS We identified 17,505 incident RA patients of whom 465 and 650 underwent THR and TKR surgery, respectively. The modeled average incidence of THR and TKR over the biologic-era was 6.57/1000 person years (PYs) and 8.51/1000 PYs, respectively, with projected (had pre-NICE TA 36 level and trend continued uninterrupted) figures of 5.63/1000 PYs and 12.92 PYs, respectively. NICE guidance was associated with a significant average decrease in TKR incidence of -4.41/1000 PYs (95% C.I. -6.88 to -1.94), equating to a relative 34% reduction. Overall, no effect was seen on THR rates. CONCLUSIONS Among incident RA patients in England and Wales, NICE guidance on TNFi therapies for RA management was temporally associated with reduced rates of TKR but not THR.
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Affiliation(s)
- Samuel Hawley
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD
| | - René Cordtz
- Centre for Rheumatology and Spine Diseases, Gentofte University Hospital, Rigshospitalet, Copenhagen, Denmark; The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lene Dreyer
- Centre for Rheumatology and Spine Diseases, Gentofte University Hospital, Rigshospitalet, Copenhagen, Denmark; The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Christopher J Edwards
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; Musculoskeletal Research Unit, NIHR Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK; Musculoskeletal Research Unit, NIHR Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK; Musculoskeletal Research Unit, NIHR Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD; GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.
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Mercer LK, Regierer AC, Mariette X, Dixon WG, Baecklund E, Hellgren K, Dreyer L, Hetland ML, Cordtz R, Hyrich K, Strangfeld A, Zink A, Canhao H, Hernandez MV, Tubach F, Gottenberg JE, Morel J, Zavada J, Iannone F, Askling J, Listing J. Spectrum of lymphomas across different drug treatment groups in rheumatoid arthritis: a European registries collaborative project. Ann Rheum Dis 2017; 76:2025-2030. [PMID: 28822981 PMCID: PMC5705847 DOI: 10.1136/annrheumdis-2017-211623] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/13/2017] [Accepted: 07/19/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Lymphomas comprise a heterogeneous group of malignant diseases with highly variable prognosis. Rheumatoid arthritis (RA) is associated with a twofold increased risk of both Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). It is unknown whether treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) affect the risk of specific lymphoma subtypes. METHODS Patients never exposed to (bionaïve) or ever treated with bDMARDs from 12 European biologic registers were followed prospectively for the occurrence of first ever histologically confirmed lymphoma. Patients were considered exposed to a bDMARD after having received the first dose. Lymphomas were attributed to the most recently received bDMARD. RESULTS Among 124 997 patients (mean age 59 years; 73.7% female), 533 lymphomas were reported. Of these, 9.5% were HL, 83.8% B-cell NHL and 6.8% T-cell NHL. No cases of hepatosplenic T-cell lymphoma were observed. Diffuse large B-cell lymphoma (DLBCL) was the most frequent B-cell NHL subtype (55.8% of all B-cell NHLs). The subtype distributions were similar between bionaïve patients and those treated with tumour necrosis factor inhibitors (TNFi). For other bDMARDs, the numbers of cases were too small to draw any conclusions. Patients with RA developed more DLBCLs and less chronic lymphocytic leukaemia compared with the general population. CONCLUSION This large collaborative analysis of European registries has successfully collated subtype information on 533 lymphomas. While the subtype distribution differs between RA and the general population, there was no evidence of any modification of the distribution of lymphoma subtypes in patients with RA treated with TNFi compared with bionaïve patients.
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Affiliation(s)
- Louise K Mercer
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Anne C Regierer
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Xavier Mariette
- Department of Rheumatology, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, Paris, France
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Eva Baecklund
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Hellgren
- Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Lene Dreyer
- Center for Rheumatology and Spine Diseases, Gentofte University Hospital, Rigshospitalet, Hellerup, Denmark.,The Parker Institute, Frederiksberg, Denmark
| | - Merete Lund Hetland
- DANBIO, Copenhagen Center for Arthritis Research, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - René Cordtz
- Center for Rheumatology and Spine Diseases, Gentofte University Hospital, Rigshospitalet, Hellerup, Denmark.,The Parker Institute, Frederiksberg, Denmark
| | - Kimme Hyrich
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK.,Musculoskeletal Biomedical Research Unit, National Institute of Health Research Manchester, Central Manchester NHS Foundation Trust, Manchester Academic Health Science, Manchester, UK
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.,CharitéUniversitätsmedizin Berlin, Berlin, Germany
| | - Helena Canhao
- EpiDoC Unit, Universidade Nova de Lisboa, CEDOC, NOVA Medical School and National School of Public Health, Lisbon, Portugal
| | | | - Florence Tubach
- Département of BIOSPIM, Département BIOSPIM Hôpital Pitié-Salpétrière, AP-HP, Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
| | | | - Jacques Morel
- Department of Rheumatology, University of Montpellier and Teaching Hospital Lapeyronie, Montpellier, France
| | - Jakub Zavada
- Institute of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Johan Askling
- Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Joachim Listing
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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Cordtz R, Mellemkjær L, Glintborg B, Hetland ML, Madsen OR, Jensen Hansen IM, Dreyer L. Risk of virus-associated cancer in female arthritis patients treated with biological DMARDs—a cohort study. Rheumatology (Oxford) 2016; 55:1017-22. [DOI: 10.1093/rheumatology/kew012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Indexed: 11/13/2022] Open
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Dreyer L, Magyari M, Laursen B, Cordtz R, Sellebjerg F, Locht H. Risk of multiple sclerosis during tumour necrosis factor inhibitor treatment for arthritis: a population-based study from DANBIO and the Danish Multiple Sclerosis Registry. Ann Rheum Dis 2015; 75:785-6. [PMID: 26698850 DOI: 10.1136/annrheumdis-2015-208490] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/24/2015] [Indexed: 11/04/2022]
Affiliation(s)
- L Dreyer
- Department of Rheumatology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - M Magyari
- The Danish Multiple Sclerosis Registry, Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Department of Neurology, The Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B Laursen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - R Cordtz
- Department of Rheumatology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - F Sellebjerg
- Department of Neurology, The Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - H Locht
- Department of Rheumatology, Frederiksberg Hospital, Frederiksberg, Denmark
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Dreyer L, Magyari M, Laursen B, Cordtz R, Sellebjerg F, Locht H. SAT0155 Multiple Sclerosis During Tumor Necrosis Factor Inhibitor Treatment for Arthritis – A Population Based Study from Danbio and the Danish Multiple Sclerosis Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Egsmose E, Cordtz R, Madsen O. AB0300 Patient Global Assessment, Pain and Fatigue Fluctuate Substantially Over Time in Rheumatoid Arthritis Patients with Stable DAS28-CRP Questioning the Value of These Patient-Reported Markers as Measures of Disease Activity in the Daily Clinic. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cordtz R, Mellemkjær L, Glintborg B, Hetland ML, Dreyer L. Malignant progression of precancerous lesions of the uterine cervix following biological DMARD therapy in patients with arthritis. Ann Rheum Dis 2015; 74:1479-80. [PMID: 25744102 DOI: 10.1136/annrheumdis-2014-206909] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 02/22/2015] [Indexed: 11/04/2022]
Affiliation(s)
- René Cordtz
- Department of Rheumatology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Lene Mellemkjær
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Bente Glintborg
- Department of Rheumatology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Merete Lund Hetland
- DANBIO Registry and Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup, Denmark Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Lene Dreyer
- Department of Rheumatology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
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Egsmose E, Cordtz R, Madsen O. SAT0056 Fatigue Fluctuations in Patients with Stable Rheumatoid Arthritis Treated with Biological Agents. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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