No increased risk for CVD events with tocilizumab over other RA biologic DMARDs
medwireNews: Tocilizumab has a cardiovascular disease (CVD) risk comparable with that of etanercept and other biologic DMARDs in individuals with rheumatoid arthritis (RA), according to findings from a large, retrospective cohort study using real-world data.
Jeffrey Curtis (University of Alabama at Birmingham, USA) and colleagues used Medicare and MarketScan claims data from 88,463 individuals with RA who had started at least one biologic DMARD in 2010 or later.
Among the Medicare patients, the crude incidence rate per 1000 person–years for the composite outcome of myocardial infarction, stroke, and fatal CVD was 12.9 for those taking the interleukin-6 receptor antagonist tocilizumab, compared with a range of 11.8 (etanercept) to 17.3 (infliximab) for those receiving other biologic DMARDs. The pooled crude incidence rate among patients exposed to any of five tumor necrosis factor (TNF) inhibitors (adalimumab, etanercept, infliximab, certolizumab, and golimumab) was 15.0 per 1000 person–years.
Indeed, the team notes that the risk for the composite CVD outcome among patients taking TNF inhibitors was significantly increased 1.27-fold compared with tocilizumab, after adjusting for factors including demographic characteristics, comorbidities, healthcare use, drug use, and smoking. This was primarily driven by a significant 1.61-fold increased risk among patients taking infliximab versus tocilizumab.
The adjusted risks associated with etanercept, abatacept, and rituximab were not significantly higher versus tocilizumab.
Similar trends were seen when the individual components of the composite CVD outcome were examined, and in subgroup analyses looking at individuals with and without a history of CVD-related conditions, the researchers report in Arthritis Care & Research. And the nonsignificant difference in CVD risk between tocilizumab and other biologic DMARDs was confirmed in the MarketScan patients.
Concern that tocilizumab might be associated with an increased risk for CVD events arose from observations showing increased low-density lipoprotein cholesterol levels associated with the drug, but the researchers say that “this concern was not borne out by our analysis.”
The researchers conclude: “[O]ur observational study confirmed results from a large randomized trial that found tocilizumab was not associated with increased or reduced CVD risk compared to etanercept.”
They continue: “We further showed that tocilizumab was associated with reduced CVD risk when compared to a pooled TNF [inhibitor] exposure, mostly attributable to the small but significantly increased CVD risk associated with infliximab.”
By Catherine Booth
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