Abatacept, TNFi reduce CVD risk in RA patients

Treatment with abatacept or tumour necrosis factor-α inhibitor (TNFi) leads to a lower risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) as compared with conventional synthetic disease-modifying antirheumatic drugs (csDMARD), suggests a study.

“Minimizing glucocorticoids (GC) use and optimizing methotrexate (MTX) dose may improve cardiovascular outcomes in patients with RA,” the investigators said.

This study examined RA patients with ≥1 year of participation in the FORWARD study (from 1998 through 2017) for incident composite CVD events (ie, myocardial infarction, stroke, heart failure, and CVD-related death validated from hospital/death records).

DMARDs were classified into seven mutually exclusive groups: csDMARD-referent, TNFi, abatacept, rituximab, tocilizumab, anakinra, and tofacitinib. GCs were assessed using a weighted cumulative exposure model that combined information about duration, intensity, and timing of exposure into a summary measure through the weighted sum of past oral doses (prednisolone equivalent). Finally, the investigators adjusted for confounders using Cox proportional hazard models.

A total of 1,801 CVD events occurred in 18,754 RA patients over a median follow-up of 4.0 years (interquartile range, 1.7–8.0). In the adjusted model, CVD risk decreased with TNFi (hazard ratio [HR], 0.81, 95 percent confidence interval [CI], 0.71–0.93) and abatacept (HR, 0.50, 95 percent CI, 0.30–0.83) relative to csDMARD.

Higher exposure to GC as weighted cumulative exposure resulted in a higher CVD risk (HR, 1.15, 95 percent CI, 1.11–1.19), but MTX use led to a risk reduction (use vs nonuse: HR, 0.82, 95 percent CI, 0.74–0.90; high dose [>15 mg/week] vs low dose [≤15 mg/week]: HR, 0.83, 95 percent CI, 0.70–0.99).