Methotrexate, Biologic Disease-Modifying Antirheumatic Drug Therapies Provide Cardioprotective Effect in Rheumatoid Arthritis

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Researchers examined the efficacy of methotrexate vs biologic disease-modifying antirheumatic drugs as protection against cardiovascular disease in rheumatoid arthritis.
Researchers examined the efficacy of methotrexate vs biologic disease-modifying antirheumatic drugs as protection against cardiovascular disease in rheumatoid arthritis.

Although rheumatoid arthritis (RA) has been linked to increased atherosclerotic cardiovascular disease (CVD), treatment with methotrexate (MTX) or biologic disease-modifying antirheumatic drugs (bDMARDs) may result in a cardioprotective effect, according to research presented at the European League Against Rheumatism (EULAR) Congress 2017.

Researchers from Philadelphia, Pennsylvania, conducted a prospective review of patients with RA to investigate 10-year CV risk and incidence of new myocardial infarction in patients treated with either MTX or bDMARD monotherapy or combination therapy.

More than 500 patients with RA were included in the review (n=517), conducted between January 2011 and March 2014. Patients underwent either bDMARD therapy (n=313) or MTX therapy (n=199); mean age was comparable between groups (57.57±12.11 vs 59.58±12.60 years). Those who received bDMARD therapy had significantly longer mean RA duration (12.63±9.95 vs 7.88±6.94 years, respectively), as well as higher rates of comorbidities.

In addition to demographic information, the researchers collected RA disease activity scores, CV risk factors, lipid parameters, and 10-year CV risk.

At 24 months, patients' Framingham Risk Score was stable in the bDMARD group; a shift was noted in the MTX group (low: 58.8% vs 69.6%; intermediate: 14.2% vs 10.1%; high: 27.0% vs 27.0%; P =.380 and .006, respectively). Significant within-group changes were noted in both the bDMARD and MTX groups (P =.016 and P <.001, respectively). Patients in both groups experienced similar instances of new myocardial infarction (3.0% vs 3.8%; P =.421). The investigators identified total comorbidities, age, and male sex (odds ratio [OR], 1.45 [95% CI, 1.24-2.20; P <.001]; OR, 1.07 [95% CI, 1.00-1.13; P =.037]; and OR, 4.00 [95% CI, 1.38-11.57; P =.011], respectively) as predictors of elevated CV or new MI.

"Significant improvement in CV risk at 24 months was observed during treatment with both MTX and bDMARDs," the researchers concluded. "As predictors of [myocardial infarction] did not include several established CV risk factors, longer studies, as well as the development of an RA-specific tool, may permit better assessment of CV risk in RA patients."

Disclosures: Dr Krasishi reports receiving research support from Roche Canada.

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Reference

Khraishi M, Stutz M, Lewis A, Molta C, Rampakakis E. Comparison of cardiovascular risk in patients with rheumatoid arthritis treated with biologics versus methotrexate: results at 24-months of follow-up. Presented at: European League Against Rheumatism (EULAR) Congress 2017; June 14-17, 2017; Madrid, Spain. Abstract FRI0153.

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