Author: Claire Barnard
medwireNews: Analysis of data from the NORD-STAR study suggests that people with early rheumatoid arthritis (RA) have increased levels of coagulation biomarkers, putting them at increased risk for venous thromboembolism, and initial treatment with DMARDs can help reduce this imbalance.
Bas Dijkshoorn (Amsterdam Rheumatology and Immunology Center, the Netherlands) and colleagues analyzed data from 24 Dutch patients who participated in NORD-STAR, a randomized trial comparing conventional treatment (n=5; either prednisolone or sulfasalazine combined with hydroxychloroquine and intra-articular corticosteroids) with certolizumab pegol (n=6), abatacept (n=7), or tocilizumab (n=6), all given alongside methotrexate, in patients with newly diagnosed RA.
The presenter said that these people had elevated levels of four coagulation biomarkers at baseline, but DMARD treatment had “profound anticoagulant effects,” with a significant reduction in these biomarkers during the first 12–24 weeks of treatment.
Specifically, average levels of factor 1+2 decreased significantly from 270.25 pmol/L at baseline to 190.36 pmol/L at week 12 and 179.52 pmol/L at week 24, while average levels of fibrinogen decreased from 4.64 to 3.61 and 2.63 g/L, respectively. The corresponding measurements were 2.17, 0.33, and 0.29 mg/L for D-dimer, and 157.38, 120.62, and 100.49 Abs-sum for overall hemostasis potential (OHP).
When comparing the different treatment arms, the interleukin (IL)-6 inhibitor tocilizumab generally performed “slightly better” than the other treatments for the reduction of fibrinogen, which could be due to the “direct effect of IL-6 on synthesis of fibrinogen,” remarked Dijkshoorn. He added that certolizumab pegol and abatacept were “very similar” in terms of their ability to reduce fibrinogen, whereas standard treatment performed “slightly worse” than the others. A similar pattern of results was seen for OHP.
The researchers also evaluated two measures of the breakdown of clots, finding that average clot lysis time decreased significantly from 1405 s at baseline to 1231 s at week 24, indicating better potential to break down clots with DMARD treatment. Overall fibrinolytic potential improved significantly from baseline to both the 12- and 24-week follow-up timepoints, from 59.97% to 63.20% and 65.25%, respectively.
Dijkshoorn noted that tocilizumab again performed “slightly better” than the other treatments for improving these measures of clot breakdown.
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EULAR 2022; Copenhagen, Denmark: 1–4 June
Ann Rheum Dis 2022; 81: 40–41