DMARD treatment does not influence secondary cardiovascular event risk
medwireNews: There is no association between type of DMARD therapy and risk for subsequent cardiovascular (CV) events among patients with inflammatory arthritis or psoriasis and pre-existing CV disease, study results suggest.
Using a US database covering administrative claims between 2006 and 2015, Jeffrey Sparks (Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA) and fellow researchers analyzed data from 10,254 patients – 8475 with rheumatoid arthritis (RA), 794 with psoriatic arthritis (PsA), and 985 with psoriasis – who had experienced an index CV event (stroke, coronary revascularization, or acute myocardial infarction) while receiving DMARD treatment.
The most commonly used antirheumatic medications at baseline were conventional DMARDs, taken by over three-quarters of patients, while the remainder were receiving either tumor necrosis factor (TNF) inhibitors or non-TNF biologic DMARDs.
As reported in Arthritis Care & Research, 15.3% of patients discontinued their DMARD treatment and 15.5% switched to another DMARD after their initial CV event.
In all, 571 patients experienced a secondary CV event over up to 1 year of follow-up. There were no significant differences in the rates of secondary CV events between patients receiving conventional DMARDs, TNF inhibitors, and non-TNF biologic DMARDs after their initial event, with corresponding age- and sex-standardized rates of 83.6, 75.2, and 122.4 per 1000 patient–years, respectively.
Although secondary CV event rates were numerically highest among patients treated with non-TNF biologic DMARDs, the researchers emphasize that the type of DMARD used was not associated with an increased risk for secondary CV events in adjusted models accounting for factors including age, sex, comorbidities, and baseline medication use.
In accordance with previously reported observations, Sparks and colleagues found that patients with RA had a significantly higher risk for secondary CV events than those with psoriasis (adjusted hazard ratio [HR]=1.55), indicating that CV risks in arthritis patients “need to be aggressively managed.”
Taken together, the study results suggest “that DMARD therapy for the underlying RA, PsA, or [psoriasis] does not appear to affect the risk for subsequent CV events, and clinicians should carefully consider continuing DMARD therapy as well as appropriate therapies for CV disease,” conclude the study authors.
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