Abatacept, TNF inhibitors linked to reduced CVD risk in RA
medwireNews: A real-world comparison of biologic, targeted synthetic, and conventional DMARDs indicates that tumor necrosis factor (TNF) inhibitors and abatacept are associated with a reduction in cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA).
As reported in The Journal of Rheumatology, the researchers drew on the FORWARD database to evaluate incident CVD risk in 18,754 RA patients (79% women) with an average age of 59 years and disease duration of 14 years who completed at least two questionnaires between 1998 and 2017. CVD events were identified from questionnaire results, medical records, physician reports, and death records.
Overall, 1801 participants experienced the composite outcome of myocardial infarction, stroke, hospitalization for heart failure, or death from CVD during a median follow-up of 4 years, giving an incidence rate of 1.78 per 1000 person–years.
Kaleb Michaud (Nebraska Medical Center, Omaha, USA) and study co-authors found that rates of the composite outcome per 1000 person–years were significantly lower among patients treated with TNF inhibitors or abatacept compared with conventional DMARDs, at 1.68 and 0.79 versus 1.84, respectively.
After adjustment for factors including age, sex, disease duration, comorbidities, and prior medications, patients in the TNF inhibitor group had a 19% lower risk for CVD than those taking conventional DMARDs, while those in the abatacept group had a 50% lower risk. Conversely, glucocorticoid use was associated with a significant 15% increased CVD risk.
When the TNF inhibitors were analyzed separately, only etanercept and infliximab were associated with a significantly lower CVD risk relative to conventional DMARDs, which the researchers attribute to “the relatively lower number of patients” taking adalimumab, golimumab, or certolizumab pegol.
There was a trend toward lower risk for CVD with all other biologic or targeted synthetic DMARDs studied – rituximab, tocilizumab, anakinra, and tofacitinib – relative to conventional DMARDs, but the between-group differences did not reach statistical significance.
The researchers speculate that “the difference in CVD benefits may be due to drug-specific mechanisms directly influencing atherosclerosis or metabolic changes,” but caution that small patient numbers for tocilizumab, anakinra, and tofacitinib “limited us in drawing conclusions regarding their associated CVD risk.”
Michaud and colleagues also evaluated the association between methotrexate use and CVD risk in a separate model, finding that methotrexate users had a significant 18% lower risk than nonusers, while those taking high-dose methotrexate (>15 mg/week) had a significant 17% lower risk than those on lower doses.
Taking all their findings into account, the researchers recommend: “Besides disease activity control, [methotrexate] dose should be optimized (>15 mg/week), glucocorticoid use should be minimized, and lastly, traditional CVD risk factors should not be forgotten to improve CV outcomes in RA patients.”
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