Some Antirheumatic Medications May Be Associated With Increased Heart Failure Risk in RA

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 diagnosis of cardiovascular disease or presence of related biomarkers, as well as the use of antirheumatic drugs may be associated with a higher risk for heart failure in patients with rheumatoid arthritis (RA), according to research presented at the 2018 ACR/ARHP Annual Meeting, held October 19-24 in Chicago, Illinois.

The purpose of this study was to identify factors associated with a higher risk for heart failure in patients with RA. Using data from the electronic health record of the Vanderbilt University Medical Center, investigators retrospectively identified 9492 adult patients with RA (89% white; 76% women; median age, 56 years) without prevalent heart failure at time of diagnosis.

They examined use of systemic corticosteroids, antimalarial (quinacrine, hydroxychloroquine, chloroquine), anti-tumor necrosis factor (TNF; ie, infliximab, golimumab, etanercept, certolizumab, and adalimumab), disease-modifying antirheumatic drugs (DMARDs; ie, sulfasalazine, methotrexate, leflunomide, cyclophosphamide, and azathioprine), and other biologic/small molecule DMARDs (ie, tofacitinib, tocilizumab, rituximab, anakinra, and abatacept).

Incident heart failure was defined as a score ≥1 for International Classification of Disease, 9^th revision (ICD-9) codes 428.x or 425.x and the use of a diuretic medication within 3 months. Multivariable-adjusted logistic regression was used to quantify associations between medications, clinical factors, and demographic factors. The median follow-up time period was 5.0 years (range, 0.1-27 years).

Of a total of 9492 patients, 522 individuals (5.5% developed incident heart failure. Atrial fibrillation, coronary artery disease, increasing age, as well as higher creatinine at baseline (first RA ICD-9 code), pulse pressure, heart rate, and body mass index were all linked to greater heart failure risk.

Risks associated with medications varied by class. Non-biologic DMARDs, systemic corticosteroids, and other biologic/small molecule DMARDs were associated with a lower risk for heart failure (P <.001 for all). Antimalarial drugs and anti-TNF agents were not associated with heart failure risk (P >.10 for both).

“Anti-rheumatic medications variably associate with [heart failure] risk, with lower risk observed among patients taking non-biologic or other biologic/small molecule DMARDs or systemic corticosteroids,” concluded the study authors.

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Reference

Ahlers M, Stein CM, Chung CP, Ormseth MJ, Farber-Eger E, Gupta D. Heart failure risk among patients with rheumatoid arthritis: association with anti-rheumatic drugs. Presented at: 2018 ACR/ARHP Annual Meeting; October 19-24, 2018; Chicago, Illinois. Abstract #496.

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