Anti-rheumatic drug use and risk of hospitalization for congestive heart failure in rheumatoid arthritis
Identifieur interne : 000252 ( Istex/Corpus ); précédent : 000251; suivant : 000253Anti-rheumatic drug use and risk of hospitalization for congestive heart failure in rheumatoid arthritis
Auteurs : S. Bernatsky ; M. Hudson ; S. SuissaSource :
- Rheumatology [ 1462-0324 ] ; 2005.
Abstract
Objective. To assess the risk of hospitalization for congestive heart failure (CHF) associated with the use of disease-modifying anti-rheumatic drugs (DMARDs) and other medications used in RA. Methods. We used a case–control design nested within an administrative database cohort of patients with rheumatoid arthritis (RA) who were dispensed a DMARD between September 1998 and December 2001. Subjects identified with a prior history of CHF were excluded. For each hospitalized case of CHF identified during follow-up, 10 controls matched on age and time were randomly selected from the cohort. Conditional logistic regression was used to estimate the rate ratio (RR) of hospitalizations for CHF associated with the current use of specific drugs, adjusted for sex and co-morbidity. Results. The cohort included 41 885 patients; 75% were women, with an average age at cohort entry of 51 yr. During follow-up, 520 hospitalizations for CHF occurred, for a rate of 10.1 per 1000 per year. The adjusted RR of CHF for current use of any DMARD was 0.7 (95% CI 0.6–0.9) relative to no current use. By DMARD category, there was evidence of a beneficial effect for both tumour necrosis factor-α antagonists (RR 0.5, 95% CI 0.2–0.9) and methotrexate monotherapy (RR 0.8, 95% CI 0.6–1.0). For non-DMARD medications, the rate of CHF was not clearly increased or decreased, except for COX-2 inhibitors. The data suggested an increased risk of CHF with rofecoxib (RR 1.3, 95% CI 1.0–3.1) and a decreased risk of CHF with celecoxib (RR 0.6, 95% CI 0.4, 1.0). Conclusions. The use of DMARDs was associated with a reduction in the risk of hospitalizations for CHF in this RA cohort. The increased risk with rofecoxib alongside a decreased risk with celecoxib suggests the absence of a class effect with respect to COX-II inhibitors for some types of cardiovascular morbidity.
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DOI: 10.1093/rheumatology/keh610
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Suissa</name><affiliation><mods:affiliation>Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada.</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Rheumatology</title><title level="j" type="abbrev">Rheumatology</title><idno type="ISSN">1462-0324</idno><idno type="eISSN">1462-0332</idno><imprint><publisher>Oxford University Press</publisher><date type="e-published" when="2005-03-22">2005</date><date when="2005-05">2005</date><biblScope unit="vol">44</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="677">677</biblScope><biblScope unit="page" to="680">680</biblScope></imprint><idno type="ISSN">1462-0324</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1462-0324</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective. To assess the risk of hospitalization for congestive heart failure (CHF) associated with the use of disease-modifying anti-rheumatic drugs (DMARDs) and other medications used in RA. Methods. We used a case–control design nested within an administrative database cohort of patients with rheumatoid arthritis (RA) who were dispensed a DMARD between September 1998 and December 2001. Subjects identified with a prior history of CHF were excluded. For each hospitalized case of CHF identified during follow-up, 10 controls matched on age and time were randomly selected from the cohort. Conditional logistic regression was used to estimate the rate ratio (RR) of hospitalizations for CHF associated with the current use of specific drugs, adjusted for sex and co-morbidity. Results. The cohort included 41 885 patients; 75% were women, with an average age at cohort entry of 51 yr. During follow-up, 520 hospitalizations for CHF occurred, for a rate of 10.1 per 1000 per year. The adjusted RR of CHF for current use of any DMARD was 0.7 (95% CI 0.6–0.9) relative to no current use. By DMARD category, there was evidence of a beneficial effect for both tumour necrosis factor-α antagonists (RR 0.5, 95% CI 0.2–0.9) and methotrexate monotherapy (RR 0.8, 95% CI 0.6–1.0). For non-DMARD medications, the rate of CHF was not clearly increased or decreased, except for COX-2 inhibitors. The data suggested an increased risk of CHF with rofecoxib (RR 1.3, 95% CI 1.0–3.1) and a decreased risk of CHF with celecoxib (RR 0.6, 95% CI 0.4, 1.0). Conclusions. The use of DMARDs was associated with a reduction in the risk of hospitalizations for CHF in this RA cohort. The increased risk with rofecoxib alongside a decreased risk with celecoxib suggests the absence of a class effect with respect to COX-II inhibitors for some types of cardiovascular morbidity.</div></front></TEI><istex><corpusName>oup</corpusName><keywords><teeft><json:string>cohort</json:string><json:string>dmard</json:string><json:string>dmards</json:string><json:string>database</json:string><json:string>rofecoxib</json:string><json:string>rheumatoid</json:string><json:string>rheumatoid arthritis</json:string><json:string>celecoxib</json:string><json:string>cohort entry</json:string><json:string>methotrexate</json:string><json:string>datum</json:string><json:string>hypertension</json:string><json:string>congestive heart failure</json:string><json:string>cardiovascular</json:string><json:string>index date</json:string><json:string>risk factor</json:string><json:string>other medication</json:string><json:string>other dmards</json:string><json:string>cardiovascular disease</json:string><json:string>medication</json:string><json:string>cardiac</json:string><json:string>ischaemic heart disease</json:string><json:string>heart failure</json:string><json:string>rate ratio</json:string><json:string>methotrexate monotherapy</json:string><json:string>current dmard</json:string><json:string>less likely</json:string><json:string>dmard prescription</json:string><json:string>inhibitor</json:string><json:string>congestive</json:string><json:string>arthritis</json:string><json:string>hospitalization</json:string><json:string>incidence rate</json:string><json:string>entry date</json:string><json:string>physician encounter</json:string><json:string>clinical epidemiology</json:string><json:string>general population</json:string><json:string>peripheral arterial disease</json:string><json:string>other heart disease</json:string><json:string>coronary artery disease</json:string><json:string>diabetes mellitus</json:string><json:string>respiratory illness</json:string><json:string>gastrointestinal disorder</json:string><json:string>central nervous system disorder</json:string><json:string>gold compound</json:string><json:string>dmard category</json:string><json:string>congestive heart failure event</json:string><json:string>large cohort</json:string><json:string>protective effect</json:string><json:string>current dmard exposure</json:string><json:string>conditional logistic regression</json:string><json:string>administrative database</json:string><json:string>study cohort</json:string><json:string>medication exposure</json:string><json:string>cardiovascular event</json:string><json:string>cohort subject</json:string></teeft></keywords><author><json:item><name>S. Bernatsky</name><affiliations><json:string>Divisions of Clinical Epidemiology, Montreal General Hospital and</json:string></affiliations></json:item><json:item><name>M. Hudson</name><affiliations><json:string>Divisions of Clinical Epidemiology, Montreal General Hospital and</json:string></affiliations></json:item><json:item><name>S. Suissa</name><affiliations><json:string>Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada.</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Congestive heart failure</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>DMARDs</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Rheumatoid arthritis</value></json:item></subject><arkIstex>ark:/67375/HXZ-26W8R0Q2-Q</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Objective. To assess the risk of hospitalization for congestive heart failure (CHF) associated with the use of disease-modifying anti-rheumatic drugs (DMARDs) and other medications used in RA. Methods. We used a case–control design nested within an administrative database cohort of patients with rheumatoid arthritis (RA) who were dispensed a DMARD between September 1998 and December 2001. Subjects identified with a prior history of CHF were excluded. For each hospitalized case of CHF identified during follow-up, 10 controls matched on age and time were randomly selected from the cohort. Conditional logistic regression was used to estimate the rate ratio (RR) of hospitalizations for CHF associated with the current use of specific drugs, adjusted for sex and co-morbidity. Results. The cohort included 41 885 patients; 75% were women, with an average age at cohort entry of 51 yr. During follow-up, 520 hospitalizations for CHF occurred, for a rate of 10.1 per 1000 per year. The adjusted RR of CHF for current use of any DMARD was 0.7 (95% CI 0.6–0.9) relative to no current use. By DMARD category, there was evidence of a beneficial effect for both tumour necrosis factor-α antagonists (RR 0.5, 95% CI 0.2–0.9) and methotrexate monotherapy (RR 0.8, 95% CI 0.6–1.0). For non-DMARD medications, the rate of CHF was not clearly increased or decreased, except for COX-2 inhibitors. The data suggested an increased risk of CHF with rofecoxib (RR 1.3, 95% CI 1.0–3.1) and a decreased risk of CHF with celecoxib (RR 0.6, 95% CI 0.4, 1.0). Conclusions. The use of DMARDs was associated with a reduction in the risk of hospitalizations for CHF in this RA cohort. The increased risk with rofecoxib alongside a decreased risk with celecoxib suggests the absence of a class effect with respect to COX-II inhibitors for some types of cardiovascular morbidity.</abstract><qualityIndicators><score>6.37</score><pdfWordCount>3370</pdfWordCount><pdfCharCount>22035</pdfCharCount><pdfVersion>1.3</pdfVersion><pdfPageCount>4</pdfPageCount><pdfPageSize>595 x 791 pts</pdfPageSize><pdfWordsPerPage>843</pdfWordsPerPage><pdfText>true</pdfText><refBibsNative>true</refBibsNative><abstractWordCount>298</abstractWordCount><abstractCharCount>1856</abstractCharCount><keywordCount>3</keywordCount></qualityIndicators><title>Anti-rheumatic drug use and risk of hospitalization for congestive heart failure in rheumatoid arthritis</title><pmid><json:string>15784627</json:string></pmid><genre><json:string>research-article</json:string></genre><host><title>Rheumatology</title><language><json:string>unknown</json:string></language><issn><json:string>1462-0324</json:string></issn><eissn><json:string>1462-0332</json:string></eissn><publisherId><json:string>brheum</json:string></publisherId><volume>44</volume><issue>5</issue><pages><first>677</first><last>680</last></pages><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>2005-03-22</json:string><json:string>between September 1998 and December 2001</json:string><json:string>6780</json:string></date><geogName></geogName><orgName><json:string>Society for Rheumatology</json:string><json:string>Lupus Canada/Retrocom</json:string><json:string>Oxford University</json:string><json:string>Pharmacoepidemiology Research Unit</json:string><json:string>Aventis</json:string><json:string>Fonds</json:string></orgName><orgName_funder><json:string>Aventis</json:string><json:string>Fonds</json:string></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Juhaeri</json:string><json:string>S. 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Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org</licence></availability><date type="e-published" when="2005-03-22">2005</date><date when="2005-05">2005</date><date type="Copyright" when="2005">2005</date></publicationStmt><notesStmt><note type="content-type" source="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="publication-type" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="article"><analytic><title level="a" type="main" xml:lang="en">Anti-rheumatic drug use and risk of hospitalization for congestive heart failure in rheumatoid arthritis</title><author xml:id="author-0000"><persName><surname>Bernatsky</surname><forename type="first">S.</forename></persName><affiliation><orgName type="department">Divisions of Clinical Epidemiology</orgName><address><addrLine>Montreal General Hospital and Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada</addrLine><country key="CA" xml:lang="en">CANADA</country></address></affiliation><affiliation role="corresp">Correspondence to: S. Suissa, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Avenue West, Ross 4.29, Montreal, Québec, Canada, H3A 1A1. E-mail: samy.suissa@clinepi.mcgill.ca</affiliation></author><author xml:id="author-0001"><persName><surname>Hudson</surname><forename type="first">M.</forename></persName><affiliation><orgName type="department">Divisions of Clinical Epidemiology</orgName><address><addrLine>Montreal General Hospital and Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada</addrLine><country key="CA" xml:lang="en">CANADA</country></address></affiliation><affiliation role="corresp">Correspondence to: S. Suissa, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Avenue West, Ross 4.29, Montreal, Québec, Canada, H3A 1A1. E-mail: samy.suissa@clinepi.mcgill.ca</affiliation></author><author xml:id="author-0002"><persName><surname>Suissa</surname><forename type="first">S.</forename></persName><affiliation><orgName type="department">Divisions of Clinical Epidemiology</orgName><address><addrLine>Montreal General Hospital and Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada</addrLine><country key="CA" xml:lang="en">CANADA</country></address></affiliation><affiliation role="corresp">Correspondence to: S. Suissa, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Avenue West, Ross 4.29, Montreal, Québec, Canada, H3A 1A1. E-mail: samy.suissa@clinepi.mcgill.ca</affiliation></author><idno type="istex">2B3D475E110E1A8B799BC758757F70306C122CE0</idno><idno type="ark">ark:/67375/HXZ-26W8R0Q2-Q</idno><idno type="other">keh610</idno><idno type="DOI">10.1093/rheumatology/keh610</idno></analytic><monogr><title level="j" type="main">Rheumatology</title><title level="j" type="abbrev">Rheumatology</title><idno type="hwp">rheumatology</idno><idno type="nlm-ta">Rheumatology (Oxford)</idno><idno type="publisher-id">brheum</idno><idno type="pISSN">1462-0324</idno><idno type="eISSN">1462-0332</idno><imprint><publisher>Oxford University Press</publisher><date type="e-published" when="2005-03-22">2005</date><date when="2005-05">2005</date><biblScope unit="vol">44</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="677">677</biblScope><biblScope unit="page" to="680">680</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><encodingDesc><schemaRef type="ODD" url="https://xml-schema.delivery.istex.fr/tei-istex.odd"></schemaRef><appInfo><application ident="pub2tei" version="1.0.10" when="2019-12-09"><label>pub2TEI-ISTEX</label><desc>A set of style sheets for converting XML documents encoded in various scientific publisher formats into a common TEI format.
<ref target="http://www.tei-c.org/">We use TEI</ref></desc></application></appInfo></encodingDesc><profileDesc><abstract xml:lang="en"><p><hi rend="italic">Objective</hi>. To assess the risk of hospitalization for congestive heart failure (CHF) associated with the use of disease-modifying anti-rheumatic drugs (DMARDs) and other medications used in RA.</p><p><hi rend="italic">Methods</hi>. We used a case–control design nested within an administrative database cohort of patients with rheumatoid arthritis (RA) who were dispensed a DMARD between September 1998 and December 2001. Subjects identified with a prior history of CHF were excluded. For each hospitalized case of CHF identified during follow-up, 10 controls matched on age and time were randomly selected from the cohort. Conditional logistic regression was used to estimate the rate ratio (RR) of hospitalizations for CHF associated with the current use of specific drugs, adjusted for sex and co-morbidity.</p><p><hi rend="italic">Results</hi>. The cohort included 41 885 patients; 75% were women, with an average age at cohort entry of 51 yr. During follow-up, 520 hospitalizations for CHF occurred, for a rate of 10.1 per 1000 per year. The adjusted RR of CHF for current use of any DMARD was 0.7 (95% CI 0.6–0.9) relative to no current use. By DMARD category, there was evidence of a beneficial effect for both tumour necrosis factor-α antagonists (RR 0.5, 95% CI 0.2–0.9) and methotrexate monotherapy (RR 0.8, 95% CI 0.6–1.0). For non-DMARD medications, the rate of CHF was not clearly increased or decreased, except for COX-2 inhibitors. The data suggested an increased risk of CHF with rofecoxib (RR 1.3, 95% CI 1.0–3.1) and a decreased risk of CHF with celecoxib (RR 0.6, 95% CI 0.4, 1.0).</p><p><hi rend="italic">Conclusions</hi>. The use of DMARDs was associated with a reduction in the risk of hospitalizations for CHF in this RA cohort. The <hi rend="italic">increased</hi> risk with rofecoxib alongside a <hi rend="italic">decreased</hi> risk with celecoxib suggests the absence of a class effect with respect to COX-II inhibitors for some types of cardiovascular morbidity.</p></abstract><textClass ana="subject"><keywords scheme="heading"><term>CLINICAL</term></keywords></textClass><textClass ana="keyword"><keywords scheme="KWD" xml:lang="en"><term>Congestive heart failure</term><term>DMARDs</term><term>Rheumatoid arthritis</term></keywords></textClass><langUsage><language ident="en"></language></langUsage></profileDesc><revisionDesc><change when="2019-12-09" who="#istex" xml:id="pub2tei">formatting</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/HXZ-26W8R0Q2-Q/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup, element #text not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="US-ASCII"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">rheumatology</journal-id><journal-id journal-id-type="nlm-ta">Rheumatology (Oxford)</journal-id>
<journal-id journal-id-type="publisher-id">brheum</journal-id><journal-title>Rheumatology</journal-title><abbrev-journal-title abbrev-type="publisher">Rheumatology</abbrev-journal-title><issn pub-type="ppub">1462-0324</issn><issn pub-type="epub">1462-0332</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">keh610</article-id><article-id pub-id-type="doi">10.1093/rheumatology/keh610</article-id><article-categories><subj-group subj-group-type="heading"><subject>CLINICAL</subject></subj-group></article-categories><title-group><article-title>Anti-rheumatic drug use and risk of hospitalization for congestive heart failure in rheumatoid arthritis</article-title></title-group><contrib-group>
<contrib contrib-type="author"><name><surname>Bernatsky</surname><given-names>S.</given-names></name>
</contrib><contrib contrib-type="author"><name><surname>Hudson</surname><given-names>M.</given-names></name>
</contrib><contrib contrib-type="author"><name><surname>Suissa</surname><given-names>S.</given-names></name>
<xref rid="AFF1">
<sup>1</sup>
</xref>
</contrib><aff>Divisions of Clinical Epidemiology, Montreal General Hospital and <target target-type="aff" id="AFF1"></target><label>1</label>Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada.</aff></contrib-group><author-notes><corresp>Correspondence to: S. Suissa, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Avenue West, Ross 4.29, Montreal, Québec, Canada, H3A 1A1. E-mail: <ext-link xlink:href="samy.suissa@clinepi.mcgill.ca" ext-link-type="email">samy.suissa@clinepi.mcgill.ca</ext-link></corresp></author-notes><pub-date pub-type="epub"><day>22</day><month>3</month><year>2005</year></pub-date><pub-date pub-type="ppub"><month>May</month><year>2005</year></pub-date><volume>44</volume><issue>5</issue><fpage>677</fpage><lpage>680</lpage><history><date date-type="received"><day>28</day><month>11</month><year>2004</year></date><date date-type="rev-recd"><day>22</day><month>2</month><year>2005</year></date></history><permissions><copyright-statement>© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org</copyright-statement><copyright-year>2005</copyright-year></permissions><abstract xml:lang="en">
<p><italic>Objective</italic>. To assess the risk of hospitalization for congestive heart failure (CHF) associated with the use of disease-modifying anti-rheumatic drugs (DMARDs) and other medications used in RA.</p>
<p><italic>Methods</italic>. We used a case–control design nested within an administrative database cohort of patients with rheumatoid arthritis (RA) who were dispensed a DMARD between September 1998 and December 2001. Subjects identified with a prior history of CHF were excluded. For each hospitalized case of CHF identified during follow-up, 10 controls matched on age and time were randomly selected from the cohort. Conditional logistic regression was used to estimate the rate ratio (RR) of hospitalizations for CHF associated with the current use of specific drugs, adjusted for sex and co-morbidity.</p>
<p><italic>Results</italic>. The cohort included 41 885 patients; 75% were women, with an average age at cohort entry of 51 yr. During follow-up, 520 hospitalizations for CHF occurred, for a rate of 10.1 per 1000 per year. The adjusted RR of CHF for current use of any DMARD was 0.7 (95% CI 0.6–0.9) relative to no current use. By DMARD category, there was evidence of a beneficial effect for both tumour necrosis factor-α antagonists (RR 0.5, 95% CI 0.2–0.9) and methotrexate monotherapy (RR 0.8, 95% CI 0.6–1.0). For non-DMARD medications, the rate of CHF was not clearly increased or decreased, except for COX-2 inhibitors. The data suggested an increased risk of CHF with rofecoxib (RR 1.3, 95% CI 1.0–3.1) and a decreased risk of CHF with celecoxib (RR 0.6, 95% CI 0.4, 1.0).</p>
<p><italic>Conclusions</italic>. The use of DMARDs was associated with a reduction in the risk of hospitalizations for CHF in this RA cohort. The <italic>increased</italic> risk with rofecoxib alongside a <italic>decreased</italic> risk with celecoxib suggests the absence of a class effect with respect to COX-II inhibitors for some types of cardiovascular morbidity.</p>
</abstract><kwd-group kwd-group-type="KWD" xml:lang="en">
<kwd>Congestive heart failure</kwd>
<kwd>DMARDs</kwd>
<kwd>Rheumatoid arthritis</kwd>
</kwd-group><custom-meta-wrap><custom-meta><meta-name>hwp-legacy-fpage</meta-name><meta-value>677</meta-value></custom-meta><custom-meta><meta-name>cover-date</meta-name><meta-value>May 2005</meta-value></custom-meta><custom-meta><meta-name>hwp-legacy-dochead</meta-name><meta-value>PAPER</meta-value></custom-meta></custom-meta-wrap></article-meta></front>
</article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Anti-rheumatic drug use and risk of hospitalization for congestive heart failure in rheumatoid arthritis</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Anti-rheumatic drug use and risk of hospitalization for congestive heart failure in rheumatoid arthritis</title></titleInfo><name type="personal"><namePart type="given">S.</namePart><namePart type="family">Bernatsky</namePart><affiliation>Divisions of Clinical Epidemiology, Montreal General Hospital and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Hudson</namePart><affiliation>Divisions of Clinical Epidemiology, Montreal General Hospital and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S.</namePart><namePart type="family">Suissa</namePart><affiliation>Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2005-05</dateIssued><copyrightDate encoding="w3cdtf">2005</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">Objective. To assess the risk of hospitalization for congestive heart failure (CHF) associated with the use of disease-modifying anti-rheumatic drugs (DMARDs) and other medications used in RA. Methods. We used a case–control design nested within an administrative database cohort of patients with rheumatoid arthritis (RA) who were dispensed a DMARD between September 1998 and December 2001. Subjects identified with a prior history of CHF were excluded. For each hospitalized case of CHF identified during follow-up, 10 controls matched on age and time were randomly selected from the cohort. Conditional logistic regression was used to estimate the rate ratio (RR) of hospitalizations for CHF associated with the current use of specific drugs, adjusted for sex and co-morbidity. Results. The cohort included 41 885 patients; 75% were women, with an average age at cohort entry of 51 yr. During follow-up, 520 hospitalizations for CHF occurred, for a rate of 10.1 per 1000 per year. The adjusted RR of CHF for current use of any DMARD was 0.7 (95% CI 0.6–0.9) relative to no current use. By DMARD category, there was evidence of a beneficial effect for both tumour necrosis factor-α antagonists (RR 0.5, 95% CI 0.2–0.9) and methotrexate monotherapy (RR 0.8, 95% CI 0.6–1.0). For non-DMARD medications, the rate of CHF was not clearly increased or decreased, except for COX-2 inhibitors. The data suggested an increased risk of CHF with rofecoxib (RR 1.3, 95% CI 1.0–3.1) and a decreased risk of CHF with celecoxib (RR 0.6, 95% CI 0.4, 1.0). Conclusions. The use of DMARDs was associated with a reduction in the risk of hospitalizations for CHF in this RA cohort. The increased risk with rofecoxib alongside a decreased risk with celecoxib suggests the absence of a class effect with respect to COX-II inhibitors for some types of cardiovascular morbidity.</abstract><note type="author-notes">Correspondence to: S. Suissa, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Avenue West, Ross 4.29, Montreal, Québec, Canada, H3A 1A1. 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