Stroke Risk in RA Driven by Precedent SAEs Requiring Hospitalization

WASHINGTON, DC – Serious adverse events (SAEs) that require hospitalization significantly impact stroke risk in patients with rheumatoid arthritis (RA). The findings were presented at the 2016 American College of Rheumatology Annual Meeting in Washington, DC.

It’s understood that patients with RA are at an increased risk for experiencing infections, hospitalizations, and cardiovascular events such as stroke; however it is not known how precedent SAEs or cardiovascular treatment impacts stroke incidence.

In this study, researchers led by Yvette Meissner, of the German Rheumatism Research Center in Berlin, Germany conducted a nested case-control study using participants enrolled in Rheumatoid Arthritis oBservation of BIologic Therapy (RABBIT), a German biologics register. The register includes RA patients on a conventional synthetic or biologic disease-modifying antirheumatic drug (DMARD) after ≥1 failure on a conventional synthetic DMARD.

Demographics, comorbidities, clinical status, disease activity, RA treatment, and SAEs are recorded every 6 months. Cases with incident non-hemorrhagic stroke were included in the analysis, with 2 controls per case.

Overall, cases and controls were older and had more cardiovascular risk factors than those remaining in the register. Treatment of RA, comorbid osteoporosis, and diabetes was treated similarly across cases and controls; however cardiovascular diseases were treated significantly less frequently in cases.

After adjustments, the researchers found that patients with treated cardiovascular diseases had only a moderately elevated risk for stroke (hazard ratio (HR) 1.41; 95% CI, 0.66-3.01) compared with patients with untreated cardiovascular disease, who showed a significantly elevated risk for stroke (HR 3.10; 95% CI, 1.41-6.79). However, patients with precedent SAEs had a 2.5-fold greater cumulative incidence of stroke compared to those with no history of SAEs, with risk greatest immediately following the SAE.

Notably, treatment with TNF inhibitors and other bDMARDS was not linked to stroke risk (HR 0.9; 95% CI, 0.6-1.4 and HR 0.7; 95% CI, 0.4-1.2, respectively).

“These results strengthen the need for better CV management in RA patients,” the authors concluded.

Reference

Meissner Y, Richter A, Kekow J, et al. The risk of stroke in patients with rheumatoid arthritis and the association with competing adverse events. Presented at: the 2016 American College of Rheumatology/ Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting. November 11-16, 2016; Washington, DC. Abstract #1993