Comparative effects of biologics on cardiovascular risk among older patients with rheumatoid arthritis
Zhang et al. - Ann Rheum Dis 2016;0:1–6 doi:10.1136/ annrheumdis-2015-207870 [Epub ahead of print]
Since RA patients are at an increased risk of a CV event, there have been several studies to determine if RA treatments alter this risk. In a retrospective study, Zhang and colleagues assess the risk of CV events in patients initiating bDMARDs.
Using Medicare medical and pharmacy claims data, the incidence rate (IR) of acute myocardial infarction (AMI) and of a composite CHD* was calculated across RA patients initiating 8 different biologics: ABA, ADA, CER, ETA, GOL, INF, RIT, and TOC. There were over 62,087 episodes of biologic initiations among 47,193 patients with RA.
ETA and INF were found to have increased AMI risk compared to ABA, while TOC was found to have decreased risk of CHD. When comparing mechanisms, anti-TNF biologics were associated with a 28% higher risk of AMI. Demographics, co-morbidities, and oral glucocorticoids use were all significantly correlated with increased CV event risk.
A higher risk of AMI was associated with anti-TNF biologics, particularly ETA and INF, compared to ABA, although the absolute rate differences were small. TOC does not increase risk for CHD events; however, these results could be confounded by contraindication to prescribing TOC to patients with perceived high CV risk. Additional data on CV risk factors and RA disease severity could be included in a future analysis to provide increased insight to RA treatment’s effect on CV risk.
*Consisted of AMI, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) ac