Supplementum 271: Abstracts of the Annual meeting of the Swiss Society of Rheumatology (Interlaken, Switzerland, August 31 − September 1, 2023)
Bibliographic record
Abstract
Background: Results of the "ORAL Surveillance" trial showed higher risk of major adverse cardiovascular (CV) events (MACE) for Janus kinase inhibitors (JAKi) than for TNF-inhibitors (TNFi).Currently, there is limited evidence of the real-world cardiovascular safety of JAKi.Objectives: To assess the incidence of MACE in rheumatoid arthritis (RA) patients treated with JAKi, compared to other biologic agents in a large multi-country real-world population.Methods: Patients from 14 RA registers from across Europe, Turkey and Québec (Canada), starting JAKi, TNF-inhibitors or bDMARDs with other modes of action (OMA), were included.MACE comprised strokes, myocardial infarctions and transient ischemic attacks and were attributed to a treatment up to 3 months after treatment cessation (except for rituximab for which it was 1 year), loss of follow-up, death or end of study.Incidence rates (IR) of MACE per 1000 patient-years (PY) with 95% confidence intervals (CI) were computed.Poisson regression, was used to obtain adjusted incidence rate ratios (IRR), with 95% CI.A sub-analysis was performed on patients aged ≥50 years and ≥1 CV risk factor, mimicking the "ORAL Surveillance" trial inclusion criteria (RCT-duplicate cohort).Results: Over the 50'325 treatment initiations considered in 34'932 patients with a mean follow-up of 2.8 years, 182 incident MACE were reported.Crude incidence was higher for OMA (2.63/1000 PY) than for JAKi (1.76/1000 PY) and TNFi (1.86/ 1000 PY).The adjusted Poisson regression demonstrated no significant difference in the incidence of MACE between JAKi vs TNFi (IRR = 0.87 (95% CI 0.56; 1.35)), and OMA vs TNFi (IRR = 1.05 (95% CI 0.74; 1.49)).The RCT-duplicate cohort accounted for 38.4% of treatment courses and had a higher incidence of MACE in each treatment group (OMA: 3.75/1000 PY, JAKi: 2.65/1000 PY, TNFi: 3.48/1000 PY).Similarly to the overall population, no significant difference in the incidence of MACE was observed between JAKi vs TNFi (IRR = 0.78 (95% CI 0.44; 1.38)), and OMA vs TNFi (IRR = 0.84 (95% CI 0.53; 1.32)). Conclusion:In this real-world study, including 14 RA registers and all currently available JAKi in the respective countries, we did not find a significantly higher risk of MACE in RA patients treated with JAKi compared to TNFi.Inclusion of other registers to increase the statistical power and the evaluation of other adverse events such as thromboembolic events, cancers and serious infections are planned.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.227 | 0.101 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".