Venous thromboembolism with JAK inhibitors and other immune-modulatory drugs: a Swedish comparative safety study among patients with rheumatoid arthritis
ObjectiveTo assess and compare the incidence of venous thromboembolism (VTE) in patients with rheumatoid arthritis (RA) treated with Janus kinase inhibitors (JAKi), tumour necrosis factor inhibitors (TNFi) or other biological disease modifying antirheumatic drugs (bDMARDs). For contextualisation, to...
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| Veröffentlicht in: | Annals of the rheumatic diseases 2023-02, Vol.82 (2), p.189-197 |
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| container_title | Annals of the rheumatic diseases |
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| creator | Molander, Viktor Bower, Hannah Frisell, Thomas Delcoigne, Benedicte Di Giuseppe, Daniela Askling, Johan Alenius, Gerd-Marie Baecklund, Eva Chatzidionysiou, Katerina Feltelius, Nils Forsblad-d’Elia, Helena Kastbom, Alf Klareskog, Lars Knight, Ann Lindqvist, Elisabet Lindström, Ulf Ljung, Lotta Turesson, Carl Sjöwall, Christopher Askling, Johan |
| description | ObjectiveTo assess and compare the incidence of venous thromboembolism (VTE) in patients with rheumatoid arthritis (RA) treated with Janus kinase inhibitors (JAKi), tumour necrosis factor inhibitors (TNFi) or other biological disease modifying antirheumatic drugs (bDMARDs). For contextualisation, to assess VTE incidences in the Swedish general population and in the RA source population.MethodsWe performed a nationwide register-based, active comparator, new user design cohort study in Sweden from 2010 to 2021. The Swedish Rheumatology Quality Register was linked to national health registers to identify treatment cohorts (exposure) of initiators of a JAKi, a TNFi, or a non-TNFi bDMARD (n=32 737 treatment initiations). We also identified a general population cohort (matched 1:5, n=92 108), and an ‘overall RA’ comparator cohort (n=85 722). Outcome was time to first VTE during the follow-up, overall and by deep vein thrombosis (DVT) and pulmonary embolism (PE). We calculated incidence rates (IR) and multivariable-adjusted HRs using Cox regression.ResultsBased on 559 incident VTE events, the age- and sex-standardised (to TNFi) IR (95% CI) for VTE was 5.15 per 1000 person-years (4.58 to 5.78) for patients treated with TNFi, 11.33 (8.54 to 15.04) for patients treated with JAKi, 5.86 (5.69 to 6.04) in the overall RA cohort and 3.28 (3.14 to 3.43) in the general population. The fully adjusted HR (95% CI) for VTE with JAKi versus TNFi was 1.73 (1.24 to 2.42), the corresponding HR for PE was 3.21 (2.11 to 4.88) and 0.83 (0.47 to 1.45) for DVT.ConclusionsPatients with RA treated with JAKi in clinical practice are at increased risk of VTE compared with those treated with bDMARDs, an increase numerically confined to PE. |
| doi_str_mv | 10.1136/ard-2022-223050 |
| format | Article |
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For contextualisation, to assess VTE incidences in the Swedish general population and in the RA source population.MethodsWe performed a nationwide register-based, active comparator, new user design cohort study in Sweden from 2010 to 2021. The Swedish Rheumatology Quality Register was linked to national health registers to identify treatment cohorts (exposure) of initiators of a JAKi, a TNFi, or a non-TNFi bDMARD (n=32 737 treatment initiations). We also identified a general population cohort (matched 1:5, n=92 108), and an ‘overall RA’ comparator cohort (n=85 722). Outcome was time to first VTE during the follow-up, overall and by deep vein thrombosis (DVT) and pulmonary embolism (PE). We calculated incidence rates (IR) and multivariable-adjusted HRs using Cox regression.ResultsBased on 559 incident VTE events, the age- and sex-standardised (to TNFi) IR (95% CI) for VTE was 5.15 per 1000 person-years (4.58 to 5.78) for patients treated with TNFi, 11.33 (8.54 to 15.04) for patients treated with JAKi, 5.86 (5.69 to 6.04) in the overall RA cohort and 3.28 (3.14 to 3.43) in the general population. The fully adjusted HR (95% CI) for VTE with JAKi versus TNFi was 1.73 (1.24 to 2.42), the corresponding HR for PE was 3.21 (2.11 to 4.88) and 0.83 (0.47 to 1.45) for DVT.ConclusionsPatients with RA treated with JAKi in clinical practice are at increased risk of VTE compared with those treated with bDMARDs, an increase numerically confined to PE.</description><identifier>ISSN: 0003-4967</identifier><identifier>ISSN: 1468-2060</identifier><identifier>EISSN: 1468-2060</identifier><identifier>DOI: 10.1136/ard-2022-223050</identifier><identifier>PMID: 36150749</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><subject>Anticoagulants ; Antirheumatic Agents ; Antirheumatic Agents - therapeutic use ; Arthritis, Rheumatoid ; Arthritis, Rheumatoid - drug therapy ; Cardiovascular Diseases ; Clinical medicine ; Cohort Studies ; Disease ; Embolism ; Epidemiology ; Humans ; Immunomodulation ; Immunosuppressive agents ; Janus kinase ; Janus Kinase Inhibitors - therapeutic use ; Patients ; Population ; Prescription drugs ; Pulmonary embolisms ; Rheumatoid Arthritis ; Rheumatology ; Surveillance ; Sweden - epidemiology ; Thromboembolism ; Thrombosis ; Tumor necrosis factor ; Tumor Necrosis Factor Inhibitors - therapeutic use ; Tumor necrosis factor-TNF ; Tumors ; Venous Thromboembolism - epidemiology</subject><ispartof>Annals of the rheumatic diseases, 2023-02, Vol.82 (2), p.189-197</ispartof><rights>Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2022 Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b560t-1df8f125f113f2493764a462c5a152ea740336d678cdc201af757daa59131faf3</citedby><cites>FETCH-LOGICAL-b560t-1df8f125f113f2493764a462c5a152ea740336d678cdc201af757daa59131faf3</cites><orcidid>0000-0003-0087-2565 ; 0000-0003-0433-0616 ; 0000-0002-2046-3833 ; 0000-0002-2716-5679 ; 0000-0002-5735-9626</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,551,777,882</link.rule.ids><linktorsrc>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:150773700$$EView_record_in_Swedish_Publication_Index_(SWEPUB)$$FView_record_in_$$GSwedish_Publication_Index_(SWEPUB)$$Hfree_for_read</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36150749$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-526811$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:150773700$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Molander, Viktor</creatorcontrib><creatorcontrib>Bower, Hannah</creatorcontrib><creatorcontrib>Frisell, Thomas</creatorcontrib><creatorcontrib>Delcoigne, Benedicte</creatorcontrib><creatorcontrib>Di Giuseppe, Daniela</creatorcontrib><creatorcontrib>Askling, Johan</creatorcontrib><creatorcontrib>Alenius, Gerd-Marie</creatorcontrib><creatorcontrib>Baecklund, Eva</creatorcontrib><creatorcontrib>Chatzidionysiou, Katerina</creatorcontrib><creatorcontrib>Feltelius, Nils</creatorcontrib><creatorcontrib>Forsblad-d’Elia, Helena</creatorcontrib><creatorcontrib>Kastbom, Alf</creatorcontrib><creatorcontrib>Klareskog, Lars</creatorcontrib><creatorcontrib>Knight, Ann</creatorcontrib><creatorcontrib>Lindqvist, Elisabet</creatorcontrib><creatorcontrib>Lindström, Ulf</creatorcontrib><creatorcontrib>Ljung, Lotta</creatorcontrib><creatorcontrib>Turesson, Carl</creatorcontrib><creatorcontrib>Sjöwall, Christopher</creatorcontrib><creatorcontrib>Askling, Johan</creatorcontrib><creatorcontrib>ARTIS study group</creatorcontrib><title>Venous thromboembolism with JAK inhibitors and other immune-modulatory drugs: a Swedish comparative safety study among patients with rheumatoid arthritis</title><title>Annals of the rheumatic diseases</title><addtitle>Ann Rheum Dis</addtitle><addtitle>Ann Rheum Dis</addtitle><description>ObjectiveTo assess and compare the incidence of venous thromboembolism (VTE) in patients with rheumatoid arthritis (RA) treated with Janus kinase inhibitors (JAKi), tumour necrosis factor inhibitors (TNFi) or other biological disease modifying antirheumatic drugs (bDMARDs). For contextualisation, to assess VTE incidences in the Swedish general population and in the RA source population.MethodsWe performed a nationwide register-based, active comparator, new user design cohort study in Sweden from 2010 to 2021. The Swedish Rheumatology Quality Register was linked to national health registers to identify treatment cohorts (exposure) of initiators of a JAKi, a TNFi, or a non-TNFi bDMARD (n=32 737 treatment initiations). We also identified a general population cohort (matched 1:5, n=92 108), and an ‘overall RA’ comparator cohort (n=85 722). Outcome was time to first VTE during the follow-up, overall and by deep vein thrombosis (DVT) and pulmonary embolism (PE). We calculated incidence rates (IR) and multivariable-adjusted HRs using Cox regression.ResultsBased on 559 incident VTE events, the age- and sex-standardised (to TNFi) IR (95% CI) for VTE was 5.15 per 1000 person-years (4.58 to 5.78) for patients treated with TNFi, 11.33 (8.54 to 15.04) for patients treated with JAKi, 5.86 (5.69 to 6.04) in the overall RA cohort and 3.28 (3.14 to 3.43) in the general population. The fully adjusted HR (95% CI) for VTE with JAKi versus TNFi was 1.73 (1.24 to 2.42), the corresponding HR for PE was 3.21 (2.11 to 4.88) and 0.83 (0.47 to 1.45) for DVT.ConclusionsPatients with RA treated with JAKi in clinical practice are at increased risk of VTE compared with those treated with bDMARDs, an increase numerically confined to PE.</description><subject>Anticoagulants</subject><subject>Antirheumatic Agents</subject><subject>Antirheumatic Agents - therapeutic use</subject><subject>Arthritis, Rheumatoid</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Cardiovascular Diseases</subject><subject>Clinical medicine</subject><subject>Cohort Studies</subject><subject>Disease</subject><subject>Embolism</subject><subject>Epidemiology</subject><subject>Humans</subject><subject>Immunomodulation</subject><subject>Immunosuppressive agents</subject><subject>Janus kinase</subject><subject>Janus Kinase Inhibitors - therapeutic use</subject><subject>Patients</subject><subject>Population</subject><subject>Prescription drugs</subject><subject>Pulmonary embolisms</subject><subject>Rheumatoid Arthritis</subject><subject>Rheumatology</subject><subject>Surveillance</subject><subject>Sweden - epidemiology</subject><subject>Thromboembolism</subject><subject>Thrombosis</subject><subject>Tumor necrosis factor</subject><subject>Tumor Necrosis Factor Inhibitors - therapeutic use</subject><subject>Tumor necrosis factor-TNF</subject><subject>Tumors</subject><subject>Venous Thromboembolism - epidemiology</subject><issn>0003-4967</issn><issn>1468-2060</issn><issn>1468-2060</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>D8T</sourceid><recordid>eNp9kstu1DAUhi0EosPAmh2yxAYJQn2J7aQLpFG5U4kF0K3lxM7EQxwPdtzRPApvi0cZCkUqC8uX853f59g_AI8xeokx5acq6IIgQgpCKGLoDljgklf5iKO7YIEQokVZc3ECHsS4yVtU4eo-OKEcMyTKegF-XprRpwinPnjXeJPHYKODOzv18OPqE7Rjbxs7-RChGjX0U28CtM6l0RTO6zSoHNtDHdI6nkEFv-yMtrGHrXdbFdRkrwyMqjPTHsYp6T1Uzo9ruM0RM05xvij0JrksZDVUIZdiJxsfgnudGqJ5dJyX4NvbN1_P3xcXn999OF9dFA3jaCqw7qoOE9bl9-hIWVPBS1Vy0jKFGTFKlIhSrrmoWt0ShFUnmNBKsRpT3KmOLkEx68ad2aZGboN1KuylV1Yej77nlZElQ7ykmX9xK__aXq6kD2uZkmSEV7mmJXg145l1Rre56aCGG1k3I6Pt5dpfybqqBK2rLPDsKBD8j2TiJJ2NrRkGNZr8c5IILHiNalFn9Ok_6ManMObXyxSvGDt8-_8pkquuGD60eTpTbfAxBtNdl4yRPHhPZu_Jg_fk7L2c8eTvTq_532bLwPMZaNzmz523yf0CFeDmfA</recordid><startdate>20230201</startdate><enddate>20230201</enddate><creator>Molander, Viktor</creator><creator>Bower, Hannah</creator><creator>Frisell, Thomas</creator><creator>Delcoigne, Benedicte</creator><creator>Di Giuseppe, Daniela</creator><creator>Askling, Johan</creator><creator>Alenius, Gerd-Marie</creator><creator>Baecklund, Eva</creator><creator>Chatzidionysiou, Katerina</creator><creator>Feltelius, Nils</creator><creator>Forsblad-d’Elia, Helena</creator><creator>Kastbom, Alf</creator><creator>Klareskog, Lars</creator><creator>Knight, Ann</creator><creator>Lindqvist, Elisabet</creator><creator>Lindström, Ulf</creator><creator>Ljung, Lotta</creator><creator>Turesson, Carl</creator><creator>Sjöwall, Christopher</creator><creator>Askling, Johan</creator><general>BMJ Publishing Group Ltd and European League Against Rheumatism</general><general>Elsevier Limited</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>DF2</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0003-0087-2565</orcidid><orcidid>https://orcid.org/0000-0003-0433-0616</orcidid><orcidid>https://orcid.org/0000-0002-2046-3833</orcidid><orcidid>https://orcid.org/0000-0002-2716-5679</orcidid><orcidid>https://orcid.org/0000-0002-5735-9626</orcidid></search><sort><creationdate>20230201</creationdate><title>Venous thromboembolism with JAK inhibitors and other immune-modulatory drugs: a Swedish comparative safety study among patients with rheumatoid arthritis</title><author>Molander, Viktor ; Bower, Hannah ; Frisell, Thomas ; Delcoigne, Benedicte ; Di Giuseppe, Daniela ; Askling, Johan ; Alenius, Gerd-Marie ; Baecklund, Eva ; Chatzidionysiou, Katerina ; Feltelius, Nils ; Forsblad-d’Elia, Helena ; Kastbom, Alf ; Klareskog, Lars ; Knight, Ann ; Lindqvist, Elisabet ; Lindström, Ulf ; Ljung, Lotta ; Turesson, Carl ; Sjöwall, Christopher ; Askling, Johan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b560t-1df8f125f113f2493764a462c5a152ea740336d678cdc201af757daa59131faf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anticoagulants</topic><topic>Antirheumatic Agents</topic><topic>Antirheumatic Agents - therapeutic use</topic><topic>Arthritis, Rheumatoid</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Cardiovascular Diseases</topic><topic>Clinical medicine</topic><topic>Cohort Studies</topic><topic>Disease</topic><topic>Embolism</topic><topic>Epidemiology</topic><topic>Humans</topic><topic>Immunomodulation</topic><topic>Immunosuppressive agents</topic><topic>Janus kinase</topic><topic>Janus Kinase Inhibitors - therapeutic use</topic><topic>Patients</topic><topic>Population</topic><topic>Prescription drugs</topic><topic>Pulmonary embolisms</topic><topic>Rheumatoid Arthritis</topic><topic>Rheumatology</topic><topic>Surveillance</topic><topic>Sweden - epidemiology</topic><topic>Thromboembolism</topic><topic>Thrombosis</topic><topic>Tumor necrosis factor</topic><topic>Tumor Necrosis Factor Inhibitors - therapeutic use</topic><topic>Tumor necrosis factor-TNF</topic><topic>Tumors</topic><topic>Venous Thromboembolism - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Molander, Viktor</creatorcontrib><creatorcontrib>Bower, Hannah</creatorcontrib><creatorcontrib>Frisell, Thomas</creatorcontrib><creatorcontrib>Delcoigne, Benedicte</creatorcontrib><creatorcontrib>Di Giuseppe, Daniela</creatorcontrib><creatorcontrib>Askling, Johan</creatorcontrib><creatorcontrib>Alenius, Gerd-Marie</creatorcontrib><creatorcontrib>Baecklund, Eva</creatorcontrib><creatorcontrib>Chatzidionysiou, Katerina</creatorcontrib><creatorcontrib>Feltelius, Nils</creatorcontrib><creatorcontrib>Forsblad-d’Elia, Helena</creatorcontrib><creatorcontrib>Kastbom, Alf</creatorcontrib><creatorcontrib>Klareskog, Lars</creatorcontrib><creatorcontrib>Knight, Ann</creatorcontrib><creatorcontrib>Lindqvist, Elisabet</creatorcontrib><creatorcontrib>Lindström, Ulf</creatorcontrib><creatorcontrib>Ljung, Lotta</creatorcontrib><creatorcontrib>Turesson, Carl</creatorcontrib><creatorcontrib>Sjöwall, Christopher</creatorcontrib><creatorcontrib>Askling, Johan</creatorcontrib><creatorcontrib>ARTIS study group</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Uppsala universitet</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Annals of the rheumatic diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Molander, Viktor</au><au>Bower, Hannah</au><au>Frisell, Thomas</au><au>Delcoigne, Benedicte</au><au>Di Giuseppe, Daniela</au><au>Askling, Johan</au><au>Alenius, Gerd-Marie</au><au>Baecklund, Eva</au><au>Chatzidionysiou, Katerina</au><au>Feltelius, Nils</au><au>Forsblad-d’Elia, Helena</au><au>Kastbom, Alf</au><au>Klareskog, Lars</au><au>Knight, Ann</au><au>Lindqvist, Elisabet</au><au>Lindström, Ulf</au><au>Ljung, Lotta</au><au>Turesson, Carl</au><au>Sjöwall, Christopher</au><au>Askling, Johan</au><aucorp>ARTIS study group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Venous thromboembolism with JAK inhibitors and other immune-modulatory drugs: a Swedish comparative safety study among patients with rheumatoid arthritis</atitle><jtitle>Annals of the rheumatic diseases</jtitle><stitle>Ann Rheum Dis</stitle><addtitle>Ann Rheum Dis</addtitle><date>2023-02-01</date><risdate>2023</risdate><volume>82</volume><issue>2</issue><spage>189</spage><epage>197</epage><pages>189-197</pages><issn>0003-4967</issn><issn>1468-2060</issn><eissn>1468-2060</eissn><abstract>ObjectiveTo assess and compare the incidence of venous thromboembolism (VTE) in patients with rheumatoid arthritis (RA) treated with Janus kinase inhibitors (JAKi), tumour necrosis factor inhibitors (TNFi) or other biological disease modifying antirheumatic drugs (bDMARDs). For contextualisation, to assess VTE incidences in the Swedish general population and in the RA source population.MethodsWe performed a nationwide register-based, active comparator, new user design cohort study in Sweden from 2010 to 2021. The Swedish Rheumatology Quality Register was linked to national health registers to identify treatment cohorts (exposure) of initiators of a JAKi, a TNFi, or a non-TNFi bDMARD (n=32 737 treatment initiations). We also identified a general population cohort (matched 1:5, n=92 108), and an ‘overall RA’ comparator cohort (n=85 722). Outcome was time to first VTE during the follow-up, overall and by deep vein thrombosis (DVT) and pulmonary embolism (PE). We calculated incidence rates (IR) and multivariable-adjusted HRs using Cox regression.ResultsBased on 559 incident VTE events, the age- and sex-standardised (to TNFi) IR (95% CI) for VTE was 5.15 per 1000 person-years (4.58 to 5.78) for patients treated with TNFi, 11.33 (8.54 to 15.04) for patients treated with JAKi, 5.86 (5.69 to 6.04) in the overall RA cohort and 3.28 (3.14 to 3.43) in the general population. The fully adjusted HR (95% CI) for VTE with JAKi versus TNFi was 1.73 (1.24 to 2.42), the corresponding HR for PE was 3.21 (2.11 to 4.88) and 0.83 (0.47 to 1.45) for DVT.ConclusionsPatients with RA treated with JAKi in clinical practice are at increased risk of VTE compared with those treated with bDMARDs, an increase numerically confined to PE.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and European League Against Rheumatism</pub><pmid>36150749</pmid><doi>10.1136/ard-2022-223050</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0087-2565</orcidid><orcidid>https://orcid.org/0000-0003-0433-0616</orcidid><orcidid>https://orcid.org/0000-0002-2046-3833</orcidid><orcidid>https://orcid.org/0000-0002-2716-5679</orcidid><orcidid>https://orcid.org/0000-0002-5735-9626</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext_linktorsrc |
| identifier | ISSN: 0003-4967 |
| ispartof | Annals of the rheumatic diseases, 2023-02, Vol.82 (2), p.189-197 |
| issn | 0003-4967 1468-2060 1468-2060 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_450643 |
| source | SWEPUB Freely available online |
| subjects | Anticoagulants Antirheumatic Agents Antirheumatic Agents - therapeutic use Arthritis, Rheumatoid Arthritis, Rheumatoid - drug therapy Cardiovascular Diseases Clinical medicine Cohort Studies Disease Embolism Epidemiology Humans Immunomodulation Immunosuppressive agents Janus kinase Janus Kinase Inhibitors - therapeutic use Patients Population Prescription drugs Pulmonary embolisms Rheumatoid Arthritis Rheumatology Surveillance Sweden - epidemiology Thromboembolism Thrombosis Tumor necrosis factor Tumor Necrosis Factor Inhibitors - therapeutic use Tumor necrosis factor-TNF Tumors Venous Thromboembolism - epidemiology |
| title | Venous thromboembolism with JAK inhibitors and other immune-modulatory drugs: a Swedish comparative safety study among patients with rheumatoid arthritis |
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