The risk of cardiovascular events associated with disease-modifying antirheumatic drugs in rheumatoid arthritis.

Like Comment
To examine the comparative effects of biologic disease-modifying antirheumatic drugs (bDMARDs) and tofacitinib against conventional synthetic (cs) DMARDs on incident cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA).RA patients with ≥1-year participation in FORWARD from 1998 through 2017 were assessed for incident composite CVD events (myocardial infarction, stroke, heart failure and CVD-related death validated from hospital/death records). DMARDs were categorized into 7 mutually exclusive groups: (1) csDMARDs-referent (2) TNFi (3) Abatacept (4) Rituximab (5) Tocilizumab (6) Anakinra (7) Tofacitinib. Glucocorticoids were assessed using a weighted cumulative exposure (WCE) model which combines information about duration, intensity, and timing of exposure into a summary measure by using the weighted sum of past oral doses (prednisolone equivalent). Cox proportional hazard models were used to adjust for confounders.During median (IQR) 4.0 (1.7-8.0) years of follow-up, 1,801 CVD events were identified in 18,754 RA patients. The adjusted model showed CVD risk reduction with TNFi (HR 0.82 [95% CI 0.72-0.94]) and abatacept (HR 0.50 [95% CI 0.30-0.83]) compared to csDMARDs. While higher glucocorticoid exposure as WCE was associated with CVD risk increase (HR 1.15 [95% CI 1.11-1.19]), methotrexate use was associated with CVD risk reduction (use vs. non-use: HR 0.82 [95% CI 0.74-0.90] and high-dose[>15mg/week] vs. lowdose[≤ 15mg/week]: HR 0.83 [95% CI 0.70-0.99]).Abatacept and TNFi were associated with decreased risk of CVD compared to csDMARDs. Minimizing glucocorticoid use and optimizing MTX dose may improve CV outcomes in patients with RA.

Get PDF with LibKey

View the article @ The Journal of rheumatology (sign-in may be required)


The wider, wiser view for healthcare professionals. ClinOwl signposts the latest clinical content from over 100 leading medical journals.
6147 Contributions
0 Following