Biologic treatment may reduce vascular risk in patients with inflammatory arthritis
medwireNews: Current use of biologic DMARDs is associated with a reduction in the risk of cardiovascular events among patients with inflammatory arthritis, suggests an analysis of the Australian Rheumatology Association Database (ARAD).
The study included 4140 patients with rheumatoid arthritis (RA; 76.5%), ankylosing spondylitis (AS; 13.6%) or psoriatic arthritis (PsA; 10.0%) who were enrolled in the database between 2001 and 2015 and followed up for an average of 5 years.
As reported in Arthritis Research & Therapy, 64.0% of patients were taking a tumour necrosis factor (TNF) inhibitor during follow-up, while 10.1% were taking other biologic DMARDs – including rituximab, abatacept, tocilizumab and anakinra – and 15.9% were biologic-naïve. A total of 10.0% of patients were receiving a biologic at baseline but discontinued its use over the course of the study.
During the study period, 13.3% of patients experienced a cardiovascular event, defined as angina, myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, other heart disease, stroke, transient ischaemic attack or cardiovascular mortality.
Premarani Sinnathurai (University of Sydney, New South Wales, Australia) and fellow researchers found that relative to biologic-naïve patients, those who were receiving TNF inhibitors had a significant 15% lower risk of experiencing cardiovascular events, while patients taking other biologics had a significant 19% reduced risk.
However, this protective association was not observed among participants who discontinued biologics during follow-up, and the researchers demonstrated no significant difference in event rates among patients with RA, AS or PsA.
“These findings support the hypothesis that control of systemic inflammation in these conditions may reduce the cardiovascular risk”, say Sinnathurai and colleagues.
They say that the elevated cardiovascular risk among inflammatory arthritis patients may be “due to inflammatory processes driven by cytokines such as [TNF], with a high inflammatory burden driving autoantibody production and apoptosis of endothelial cells to cause vascular damage and a pro-thrombotic state”, and suggest that there could be “an intrinsic causative benefit of biologic therapy.”
The researchers caution, however, that their observational study was “only able to show an association and not causation”, and that their findings may be subject to selection bias.
Rheumatologists may “choose to prescribe biologics for healthier patients, or to patients with higher levels of education or socioeconomic status who are consequently at lower risk of cardiovascular disease”, they explain.
The study authors also note that information on disease activity was not available in the ARAD. They say it is possible that tight disease control as a result of biologic therapy may have led to a reduction in cardiovascular event rates, “rather than an intrinsic effect of the biologics themselves acting on vascular inflammation.”
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