CVD Risk Reduced in Rheumatoid Arthritis Treated With Methotrexate and bDMARDs

The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .

CHICAGO — A reduction in risk for cardiovascular disease (CVD) has been reported among patients with rheumatoid arthritis (RA) who are receiving concomitant therapy with methotrexate (MTX) and biologic disease-modifying antirheumatic drugs (bDMARDs), according to the results of a retrospective cohort study presented at the 2018 ACR/ARHP Annual Meeting, held October 19-24, in Chicago, Illinois.

Recognizing that the effect of concomitant MTX use on CVD risk among patients with RA who are initiating bDMARDs remains unknown, the investigators used 2006 to 2015 Medicare claims data for their analysis.

Follow-up commenced at initiation (index date) and concluded at the earliest occurrence of 1 of the following: (1) end of exposure of the specific bDMARD (days of supply with 90-day extension); (2) switch to another bDMARD or to tofacitinib; (3) CVD event; (4) death date; (5) loss of Medicare coverage; or (6) end of study.

MTX use was defined as follows: (1) concomitant MTX use, with prescription for MTX within 120 days after the index date and (2) time-varying MTX, which denoted prescription date to prescription date plus days of supply without extension. A 90-day extension was added to days of supply, for sensitivity analysis. The primary study outcome was the composite of incident myocardial infarction, incident stroke, and fatal CVD.

A total of 88,255 DMARD initiators (64,218 patients) were included in the analysis. Average participant age at study initiation was 64.6 ± 12.3 years. Overall, 84.0% of the patients were women, and 68.2% were non-Hispanic white individuals. Crude incidence rates (IRs) for CVD were 13.1 (95% CI, 12.2-14.0) and 18.7 (95% CI, 17.6-19.9) events per 1000 person-years among patients with RA receiving and not receiving concomitant MTX, respectively.

Moreover, crude IRs for CVD were 12.1 (95% CI, 11.1-13.2) and 17.9 (95% CI, 16.9-18.8) events per 1000 person-years for patients with RA with and without time-varying MTX, respectively.

Reported P values were as follows: (1) P = .0189 for the interaction between concomitant MTX and background bDMARDs and (2) P =.0030 for the interaction between time-varying MTX and background bDMARDs. 

Contrast hazard ratios (HRs) for concomitant MTX varied from 0.61 (95% CI, 0.37-1.01) in golimumab initiators to 0.97 (95% CI, 0.74-1.26) in adalimumab initiators. Contrast HRs for time-varying MTX ranged from 0.58 (95% CI, 0.35-0.96) in certolizumab initiators to 0.90 (95% CI, 0.68-1.18) in adalimumab initiators.

The investigators concluded that among bDMARD-treated patients with RA, an overall reduction of 23% in risk for CVD is associated with concomitant MTX use. The effect size varies among the different background bDMARDs.

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Reference

Xie F, Chen L, Levitan E, Muntner PM, Curtis JR. Methotrexate use and the risk for cardiovascular disease among rheumatoid patients initiating biologic disease-modifying anti-rheumatic drugs. Presented at: ACR Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 2814.

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