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Disease‐Modifying Antirheumatic Drug Use and the Risk of Incident Hyperlipidemia in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study
Author(s) -
Desai Rishi J.,
Eddings Wesley,
Liao Katherine P.,
Solomon Daniel H.,
Kim Seoyoung C.
Publication year - 2015
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22483
Subject(s) - medicine , rheumatoid arthritis , hazard ratio , hydroxychloroquine , cohort , rosuvastatin , proportional hazards model , hyperlipidemia , cohort study , retrospective cohort study , confidence interval , disease , endocrinology , diabetes mellitus , covid-19 , infectious disease (medical specialty)
Objective To compare the risk of incident hyperlipidemia in early rheumatoid arthritis (RA) patients after initiation of various disease‐modifying antirheumatic drugs (DMARDs). Methods We conducted a cohort study using insurance claims data (2001–2012) in early RA patients. Early RA was defined by the absence of any RA diagnosis or DMARD prescriptions for 12 months. Four mutually exclusive groups were defined based on DMARD initiation: tumor necrosis factor α (TNFα) inhibitors ± nonbiologic (nb) DMARDs, methotrexate (MTX) ± nonhydroxycholorquine nbDMARDs, hydroxychloroquine ± non‐MTX nbDMARDs, and other nbDMARDs only. The primary outcome was incident hyperlipidemia, defined by a diagnosis and a prescription for a lipid‐lowering agent. For the subgroup of patients with laboratory results available, change in lipid levels was assessed. Multivariable Cox proportional hazard models and propensity score (PS) decile stratification with asymmetric trimming were used to control for confounding. Results Of the 17,145 early RA patients included in the study, 364 developed incident hyperlipidemia. The adjusted hazard ratios (HRs; 95% confidence intervals [95% CIs]) for hyperlipidemia were 1.41 (95% CI 0.99, 2.00) for TNFα inhibitors, 0.81 (95% CI 0.63, 1.04) for hydroxychloroquine, and 1.33 (95% CI 0.95, 1.84) for other nbDMARDs compared with MTX in the full cohort, while HRs for the PS trimmed cohort were 1.18 (95% CI 0.80, 1.73), 0.75 (95% CI 0.58, 0.98), and 1.41 (95% CI 1.01, 1.98), respectively. In the subgroup analysis, hydroxychloroquine use showed significant reduction in low‐density lipoprotein (−8.9 mg/dl, 95% CI −15.8, −2.0), total cholesterol (−12.3 mg/dl, 95% CI −19.8, −4.8) and triglyceride levels (−19.5 mg/dl, 95% CI −38.7, −0.3) from baseline compared with MTX. Conclusion Use of hydroxychloroquine may be associated with a lower risk of hyperlipidemia among early RA patients.