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Impact of TNF inhibitor therapy on joint replacement rates in rheumatoid arthritis: a matched cohort analysis of BSRBR-RA UK registry data

Impact of TNF inhibitor therapy on joint replacement rates in rheumatoid arthritis: a matched cohort analysis of BSRBR-RA UK registry data
Impact of TNF inhibitor therapy on joint replacement rates in rheumatoid arthritis: a matched cohort analysis of BSRBR-RA UK registry data
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.

Biologics, Comparative effectiveness, Epidemiology, Joint replacement, Rheumatoid arthritis, TNF inhibitor, Total hip replacement, Total knee replacement
1462-0324
1168-1175
Hawley, Samuel
407712ed-30ba-4458-a0f3-f6278e219845
Sanni, M.
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Cordtz, Rene
10518317-7fad-4d02-b546-88f77c4c9154
Dreyer, Lene
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Edwards, Christopher J.
21cdd4bc-3812-4fc4-bf26-0b2908aff846
Arden, Nigel K.
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Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Judge, Andrew
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Hyrich, Kimme L.
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Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Hawley, Samuel
407712ed-30ba-4458-a0f3-f6278e219845
Sanni, M.
18a8f9b9-ac0f-4162-bd8b-3d682865b36b
Cordtz, Rene
10518317-7fad-4d02-b546-88f77c4c9154
Dreyer, Lene
9fd5a36c-1d7d-4171-ba4e-fc19cd420677
Edwards, Christopher J.
21cdd4bc-3812-4fc4-bf26-0b2908aff846
Arden, Nigel K.
0f42ab7a-9e94-4f9e-aa45-20d061acab28
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Hyrich, Kimme L.
bf2bc52a-6d8a-4ca3-9266-8e471155fad9
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9

Hawley, Samuel, Sanni, M., Cordtz, Rene, Dreyer, Lene, Edwards, Christopher J., Arden, Nigel K., Cooper, Cyrus, Judge, Andrew, Hyrich, Kimme L. and Prieto-Alhambra, Daniel (2019) Impact of TNF inhibitor therapy on joint replacement rates in rheumatoid arthritis: a matched cohort analysis of BSRBR-RA UK registry data. Rheumatology, 58 (7), 1168-1175. (doi:10.1093/rheumatology/key424).

Record type: Article

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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More information

Accepted/In Press date: 3 November 2018
e-pub ahead of print date: 10 January 2019
Published date: 1 July 2019
Keywords: Biologics, Comparative effectiveness, Epidemiology, Joint replacement, Rheumatoid arthritis, TNF inhibitor, Total hip replacement, Total knee replacement

Identifiers

Local EPrints ID: 427698
URI: http://eprints.soton.ac.uk/id/eprint/427698
ISSN: 1462-0324
PURE UUID: 455c5bfd-8df2-46b5-acf6-6963b696879e
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 25 Jan 2019 17:30
Last modified: 26 Nov 2021 05:21

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Contributors

Author: Samuel Hawley
Author: M. Sanni
Author: Rene Cordtz
Author: Lene Dreyer
Author: Christopher J. Edwards
Author: Nigel K. Arden
Author: Cyrus Cooper ORCID iD
Author: Andrew Judge
Author: Kimme L. Hyrich
Author: Daniel Prieto-Alhambra

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