medwireNews: Among patients with active rheumatoid arthritis (RA), adding tumor necrosis factor (TNF) inhibitors to methotrexate is associated with a similar reduction in vascular inflammation to that seen with add-on sulfasalazine plus hydroxychloroquine, suggest findings from a randomized controlled trial.
The study, reported in the Annals of the Rheumatic Diseases, included 115 individuals with RA and continued moderate disease activity despite treatment with methotrexate at a weekly dose of at least 15 mg (median 20 mg) for 8 weeks or more. Participants were aged a median of 58.0 years, with a median RA duration of 1.4 years, and a third were taking glucocorticoids in addition to methotrexate.
These people were randomly assigned to receive TNF inhibitors (adalimumab 40 mg every 2 weeks or etanercept 50 mg every 2 weeks) or sulfasalazine 1 g twice per day plus hydroxychloroquine 200 mg twice per day (triple therapy group).
Daniel Solomon (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and co-investigators found that participants in both groups experienced “clinically important improvements” in arterial inflammation from baseline to week 24, with no significant between-group difference.
Specifically, the team measured the maximum arterial target-to-background ratio (TBR) in the most diseased segment of the carotid artery or aorta, which is a measure of 18F-fluorodeoxyglucose (FDG) uptake in FDG-positron emission tomography/computed tomography (FDG-PET/CT) scans and correlates with markers of inflammation. This improved from a mean of 2.72 at baseline to 2.47 at week 24 in the TNF inhibitor group, and from 2.62 to 2.43 in the triple therapy arm, giving comparable reductions of 0.24 and 0.19, respectively.
“[T]he 7%–9% reduction in the arterial FDG signal that was seen in both treatment arms is similar to the signal reduction previously achieved with 10 mg atorvastatin,” point out the researchers.
“Thus, the degree of arterial inflammation reduction seen in the current study is similar to that seen with moderate intensity statin therapy, which is known to significantly lower CV [cardiovascular] risk,” they add.
Solomon and team’s findings were consistent across subgroups by age, sex, glucocorticoid and statin use, CV risk factors, RA duration, and serologic status. They note that there was “a trend towards more glucocorticoid use” among people given triple therapy versus TNF inhibitors, with 37.5% and 24.1% of participants, respectively, taking glucocorticoids at week 24.
In accordance with the TBR results, measures of RA disease activity including DAS28-CRP and tender and swollen joint counts significantly decreased over the study period, with no significant differences between the groups. There was no significant correlation between DAS28-CRP and improvements in TBR.
The study authors say that future PET-CT studies should investigate “RA therapies with differing mechanisms than the ones used in this study.”
Moreover, additional research is required to “explore the mechanisms by which RA therapies appear to ameliorate vascular inflammation independent of their effect on articular disease activity,” they conclude.
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