本研究对风湿性关节炎（RA）中的疾病修饰抗风湿药物（DMARDs）与心血管疾病（CVD）的风险进行了调查。这项嵌套病例对照研究使用了市场扫描数据库（2012-2014年），涉及成年RA患者（年龄≥18岁），他们在2013年1月1日至2014年12月31日期间开始使用传统合成（cs）DMARD、生物制剂DMARD或定向合成（ts）DMARD（入组时间点），且没有心血管疾病史。病例是根据医疗索赔的诊断代码或程序代码确定的新发CVD个体。对于每个病例，通过使用带替换的新发密度抽样方法选择10个年龄和性别匹配的对照组。在事件日期前的90天内测量DMARD的处方。条件 logistic 回归分析了在联合治疗或个别使用DMARD的情况下与CVD的风险相关性，并与单独使用甲氨蝶呤（MTX）治疗进行了基线混杂因素的调整。亚组分析在DMARD联合治疗用户或单独使用DMARD的用户中分别进行。总共包括270例新发CVD和2700个对照（年龄：54 [1]；75.6%女性）。常规开方的DMARD疗法是csDMARD单药治疗（n = 795，27.04%），其次是肿瘤坏死因子抑制剂（TNFi）单药治疗（n = 367，12.48%），以及与MTX联合应用的TNFi（n = 314，10.68%）。与MTX单药治疗相比，DMARD药物的总体使用与CVD的差异性风险无关，包括各种类型的DMARD联合治疗方案。亚组分析结果相似。该研究发现，在RA患者中，与MTX单药治疗相比，DMARD的联合治疗或单药治疗与CVD的差异风险无关。要点：• 本研究评估了风湿性关节炎（RA）中疾病修饰抗风湿药物（DMARDs）与心血管疾病（CVD）的风险。• 结果表明，在早期RA患者中，与MTX单药治疗相比，DMARD与MTX联合应用或单独使用与CVD的差异风险无关。• 进一步工作应着重对DMARD联合治疗与MTX在调节心血管风险方面的机制进行更好的理解。©2023年。作者们在国际风湿学联盟（ILAR）独家许可下发表的文章。

This study examined the risk of cardiovascular disease (CVD) associated with the disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA).This nested case-control study used the MarketScan database (2012-2014), involving adult RA patients (aged ≥18 years) initiating either a conventional synthetic (cs) DMARD, biologic DMARD, or targeted synthetic (ts) DMARD between January 1, 2013 and December 31, 2014 (cohort entry) and had no CVD history. Cases were individuals with incident CVD identified using diagnosis codes or procedure codes from medical claims. For each case, 10 age- and sex-matched controls were selected using the incident density sampling with replacement. Prescriptions of DMARDs were measured 90 days before the event date. Conditional logistic regression examined the association of risk of CVD with DMARDs in combination treatment or individual use, with reference to methotrexate (MTX) monotherapy, adjusting for baseline confounders. Subgroup analyses were performed separately in DMARD combination therapy users or individual DMARD users, respectively.In total, 270 cases of incident CVD and 2700 controls were included (mean [standard deviation (SD)] age: 54 [1]; 75.6% women). The commonly prescribed DMARD therapies were csDMARD monotherapy (n = 795, 27.04%), followed by  tumor necrosis factor inhibitors (TNFi) monotherapy (n = 367, 12.48%), and TNFi in combination with MTX (n = 314, 10.68%). Compared with MTX monotherapy, overall use of DMARD agents was not associated with the differential risk of CVD, including various types of DMARD combination regimens. The findings were similar across subgroup analyses.The study found no differential risk of CVD with DMARDs in combination therapy or monotherapy compared to MTX monotherapy in patients with RA. Key Points • This study evaluated the risk of cardiovascular disease (CVD) associated with the disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA). • Findings suggest no differential CVD risk with DMARDs in combination with MTX or used individually compared with MTX monotherapy in patients with early RA. • Further efforts should focus on a better understanding of the mechanism of DMARD combination treatments with MTX in modifying CV risk.© 2023. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).