Journal article
The Risk of Cardiovascular Events Associated With Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis
Journal of rheumatology, Vol.48(5), pp.648-655
05/01/2021
DOI: 10.3899/jrheum.200265
PMID: 32801134
Abstract
Objective. To examine the comparative effects of biologic disease-modifying antirheumatic drugs (bDMARD) and tofacitinib against conventional synthetic DMARD (csDMARD) on incident cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA).
Methods. RA patients with >= 1 year of participation in the FORWARD study, from 1998 through 2017, were assessed for incident composite CND events (myocardial infarction, stroke, heart failure, and CVD-related death validated from hospital/death records). DMA RD were categorized into 7 mutually exclusive groups: (1) csDMARD-referent; (2) tumor necrosis factor-a inhibitor (TNFi); (3) abatacept (ABA); (4) rituximab; (5) tocilizumab; (6) anakinra; and (7) tofacitinib. Glucocorticoids (GC) were assessed using a weighted cumulative exposure 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.
Results. During median (IQR) 4.0 (1.7-8.0) years of follow-up, 1801 CVD events were identified in 18,754 RA patients. The adjusted model showed CVD risk reduction with TNFi (HR 0.81, 95% CI 0.71-0.93) and ABA (I IR 0.50, 95% CI 0.30-0.83) compared to csDMARD. While higher GC exposure as weighted cumulative exposure was associated with increased CVD risk (HR 1.15, 95% CI 1.11-1.19), methotrexate (MTX) use was associated with CND risk reduction [use vs nonuse HR 0.82, 95% CI 0.74-0.90, and high dose (> 15 mg/week) vs low dose (<= 15 tng/week) HR 0.83, 95% CI 0.70-0.99].
Conclusion. ABA and TNFi were associated with decreased risk of CVD compared to csDMARD. Minimizing GC use and optimizing MTX dose may improve cardiovascular outcomes in patients with RA.
Details
- Title: Subtitle
- The Risk of Cardiovascular Events Associated With Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis
- Creators
- Gulsen Ozen - University of Nebraska Medical CenterSofia Pedro - The National Databank for Rheumatic DiseasesKaleb Michaud - The National Databank for Rheumatic Diseases
- Resource Type
- Journal article
- Publication Details
- Journal of rheumatology, Vol.48(5), pp.648-655
- Publisher
- J Rheumatol Publ Co
- DOI
- 10.3899/jrheum.200265
- PMID
- 32801134
- ISSN
- 0315-162X
- eISSN
- 1499-2752
- Number of pages
- 8
- Grant note
- Pfizer through the ASPIRE competitive grant program Rheumatology Research Foundation
- Language
- English
- Date published
- 05/01/2021
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984702941302771
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