Use of disease-modifying antirheumatic drugs (DMARDs) in combination therapy or individually compared with methotrexate (MTX) monotherapy presents no differential cardiovascular disease (CVD) risk among patients with rheumatoid arthritis (RA); choice of DMARD therapy may be based on clinical parameters and treatment response, according to study findings published in Clinical Rheumatology.
Investigators assessed the risk for CVD associated with DMARD use among patients with RA.
A nested case-control study was conducted to identify cases of incident CVD among adult patients with RA and no history of CVD who initiated either a conventional synthetic DMARD (csDMARD), biologic DMARD (bDMARD), or targeted synthetic DMARD (tsDMARD) from January 2013 through December 2014. Cases were identified from medical claims codes. Ten sex- and age-matched control patients were selected for each case. The use of DMARDs was determined through prescriptions filled.
An incident cardiovascular event (composite of medical visits with a diagnosis of stroke, myocardial infarction, heart failure, or need for revascularization procedures) was the primary endpoint.
A total of 270 cases of CVD were matched with 2700 members of the control group (mean age, 54 years; 75.6% women). The most commonly prescribed DMARD was csDMARD monotherapy (n=795; 27.04% of all participants), followed by tumor necrosis factor (TNF) inhibitor monotherapy (n=367; 12.48% of all participants), TNF inhibitor therapy in combination with MTX (n=314; 10.68% of all participants), and csDMARD therapy in combination with MTX (n=295; 10.03% of all participants). Methotrexate monotherapy was prescribed to 162 patients (5.51% of all participants).
Case and control groups were comparable for RA severity index and RA-related comorbidities, excluding hospitalization for infection. The groups were not comparable for use of oral glucocorticoids or opioids.
The overall use of DMARDs vs MTX monotherapy was not associated with a differential risk for CVD (csDMARD monotherapy: adjusted odds ratio [aOR], 1.552; TNF inhibitor monotherapy: aOR, 1.379; TNF inhibitor therapy in combination with MTX: aOR, 1.306; csDMARD therapy in combination with MTX: aOR, 0.859). The results of these findings were similar across subgroup analyses.
Study limitations included the observational design, residual or unmeasured confounding, misclassification and coding errors, and a lack of data on long-term exposure to DMARDs and cardiovascular risk.
The study authors concluded, “With no differential [cardiovascular] risk for DMARDs, the choice of DMARD therapy could be based on the treatment response and other clinical parameters.”
Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Huang Y, Agarwal SK, Chatterjee S, Chen H, Johnson ML, Aparasu RR. Risk of incident cardiovascular events with disease-modifying anti-rheumatic drugs among adults with rheumatoid arthritis: a nested case-control study. Clin Rheumatol. Published online August 4, 2023. doi:10.1007/s10067-023-06709-2