Association between anti-TNF-α therapy and all-cause mortality.

Academic Article


  • PURPOSE: To compare mortality among patients with selected autoimmune diseases treated with anti-tumor necrosis factor alpha (TNF-α) agents with similar patients treated with non-biologic therapies. METHODS: Cohort study set within several large health care programs, 1998-2007. Autoimmune disease patients were identified using diagnoses from computerized healthcare data. Use of anti-TNF-α agents and comparison of non-biologic therapies were identified from pharmacy data, and mortality was identified from vital records and other sources. We compared new users of anti-TNF-α agents to new users of non-biologic therapies using propensity scores and Cox proportional hazards analysis to adjust for baseline differences. We also made head-to-head comparisons among anti-TNF-α agents. RESULTS: Among the 46 424 persons included in the analysis, 2924 (6.3%) had died by the end of follow-up, including 1754 (6.1%) of the 28 941 with a dispensing of anti-TNF-α agent and 1170 (6.7%) of the 17 483 who used non-biologic treatment alone. Compared to use of non-biologic therapies, use of anti-TNF-α therapy was not associated with an increased mortality in patients with rheumatoid arthritis (adjusted hazard ratio [aHR] 0.93 with 95% confidence intervals (CI) 0.85-1.03); psoriasis, psoriatic arthritis, or ankylosing spondylitis (combined aHR 0.81 with CI 0.61-1.06; or inflammatory bowel disease (aHR 1.12 with CI 0.85-1.46). Mortality rates did not differ to an important degree between patients treated with etanercept, adalimumab, or infliximab. CONCLUSION: Anti-TNF-α therapy was not associated with increased mortality among patients with autoimmune diseases.
  • Published In


  • Adalimumab, Adolescent, Adult, Aged, Aged, 80 and over, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Autoimmune Diseases, Child, Child, Preschool, Cohort Studies, Etanercept, Female, Humans, Immunoglobulin G, Infant, Infant, Newborn, Infliximab, Male, Middle Aged, Mortality, Proportional Hazards Models, Receptors, Tumor Necrosis Factor, Tumor Necrosis Factor-alpha
  • Digital Object Identifier (doi)

    Author List

  • Herrinton LJ; Liu L; Chen L; Harrold LR; Raebel MA; Curtis JR; Griffin MR; Solomon DH; Saag KG; Lewis JD
  • Start Page

  • 1311
  • End Page

  • 1320
  • Volume

  • 21
  • Issue

  • 12