Cardiovascular Safety of Tocilizumab versus Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid Arthritis – a Multi-database Cohort Study
Arthritis Rheumatol 2017 Feb 28. doi: 10.1002/art.40084This multi-database population-based US cohort study found no evidence of an increased cardiovascular (CV) risk among RA patients who switched from a different biologic drug or tofacitinib to tocilizumab (TCZ) versus to a TNF inhibitor (TNFi).The study used claims data in patients with RA newly starting treatment with TCZ or a TNFi from three large databases: Medicare (n=7397), PharMetrics (n=8119) and MarketScan (n=12512). Included within the analysis were 9218 TCZ initiators propensity-score matched to 18810 TNFi initiators. The primary outcome was a composite CV endpoint of hospitalisation for myocardial infarction or stroke.The incidence rate for composite CV events was 0.52 per 100 person-years in TCZ initiators and 0.59 per 100 person-years in TNFi initiators. The risk of CV events associated with TCZ use versus TNFi was similar across all three databases, with a combined hazard ratio of 0.84 (95%CI 0.56–1.26. The results were consistent in secondary and clinically important subgroup analyses.Despite the increase in LDL cholesterol seen in patients treated with TCZ, there does not appear to be an increase in the risk of CV events.