Tocilizumab not linked to elevated cardiovascular risk in RA patients
medwireNews: Patients with rheumatoid arthritis (RA) who are treated with tocilizumab have a similar cardiovascular (CV) risk profile to those taking most other biological DMARDs, results of a real-world study suggest.
“Multiple studies have observed seemingly unfavorable changes in lipid profiles associated with IL6 receptor (IL-6R) antagonists and some other rheumatoid arthritis therapies”, but “[t]he real-world cardiovascular disease (CVD) risk associated with the first approved anti IL-6R medication for RA, tocilizumab, remains uncertain”, say the study authors.
Jeffrey Curtis (University of Alabama at Birmingham, USA) and colleagues used claims data from Medicare and MarketScan to investigate the occurrence of CVD among 88,463 RA patients who were included in the databases between 2006 and 2015.
In the Medicare database, the 9561 patients treated with infliximab had the highest incidence of myocardial infarction, stroke or fatal CVD (the composite CV endpoint), at 17.3 per 1000 patient–years, while the 8,082 patients given etanercept had the lowest rate at 11.8 per 1000 patient–years. The incidence of the composite outcome was 12.9 per 1000 patient–years among the 7369 patients treated with tocilizumab.
When the tocilizumab group was used as the reference, patients treated with infliximab had a significant 61% higher risk of experiencing the composite CV outcome, whereas there was no significant difference in risk among those given tocilizumab versus etanercept, adalimumab, abatacept or rituximab.
Similarly, in the MarketScan database, there was no statistically significant difference in rates of the composite CV endpoint among patients receiving tocilizumab versus any of the other biological agents. The team notes that the CVD incidence rates in MarketScan, which ranged from 5.2 per 1000 person–years for tocilizumab to 11.0 per 1000 person–years for rituximab, “were about 50% lower” than those in the Medicare database, possibly due to patients having a younger average age (51.7 vs 64.2 years).
Together, these findings demonstrate “no increased risk for patients treated with [tocilizumab] compared to most other RA biologics including etanercept and abatacept”, write Curtis and colleagues in Arthritis Care & Research.
They emphasize that their results “were robust” after adjustment for RA disease activity, as well as in “numerous subgroup analyses”, including when patients were categorised by prior CVD and by previous exposure to biological DMARDs, which “extended the generalizability of the main results”.
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