Out of the severe complexities of rheumatoid arthritis (RA), the coronary artery diseases (CAD) leads. Amid anti-rheumatoid therapies, DMARDs and COXi are linked with lessened cardiovascular disease, but it is uncertain that the combination of both reduces the CAD risk or vice versa. This population-based cohort study highlights the consequences of combination on cardiovascular health.

To discover whether the anti-rheumatic drugs combination is linked with the coronary artery diseases (CAD) among patients with incident rheumatoid arthritis (RA).

This population-based cohort study utilised administrative data to categorised 6260 newly-diagnosed RA patients with an age of  ≥20 years as the study group. The appearance of CAD according to the ICD-9-CM codes was taken as study end-point. The assessment of exposure to various drugs combinations and related risk of CAD was done. These involved multiple combinations of methotrexate (MTX), sulfasalazine (SSZ), celecoxib (Cx) and hydroxychloroquine (HCQ). The reference group included patients who were never used Cx, HCQ, MTX, or SSZ. Estimation of the hazard ratio (HR) of disease was done via Cox proportional hazards model after adjusting demographic and other co-morbidities. The spline curve of the Scaled Schoenfeld residuals was implemented to illustrate the estimated impact on CAD overtime for drug usage in case the proportionality theory was disrupted.

The RA patients exhibited 0.29 (0.19–0.44), 0.46 (0.24–0.88), and 0.42 (0.24– 0.75)  adjusted HR (95% confidence interval) of CAD for “Cx only”, “Cx and HCQ ever”, and “Cx, HCQ, MTX, and SSZ ever” respectively throughout the first phase of 0–3,  4, or 7 years. During the second time of 3, 4, or 7–10 years, they shifted to 1.04 (0.78–1.38), 1.16 (0.62–2.19), and 0.59 (0.32–1.08), respectively. The “Cx, MTX, and SSZ ever” showed constant adjusted HR (95% CI) at 0.12 (0.02–0.89).

Celecoxib-DMARDs drug combinations were correlated with lowered CAD risk on incident RA patients, and some of them presented the time-varying drug impact.