Little Variation in Risk for Acute Coronary Syndrome Among Patients With RA Initiating Different bDMARDs

Illustration of the human heart
Illustration of the human heart
Researchers assessed the risks for short-, intermediate-, and long-term acute coronary syndrome among patients with rheumatoid arthritis initiating treatment with biologic disease-modifying antirheumatic drugs.

The incidence rate (IR) of acute coronary syndrome (ACS) among patients with rheumatoid arthritis (RA) initiating treatment with biologic disease-modifying antirheumatic drugs (bDMARD) was found to be elevated compared with that of the general population, according to results of a study published in Annals of the Rheumatic Diseases. However, the short-, intermediate-, and long-term risks of ACS did not vary significantly across different bDMARDs.

Although patients with RA are at increased risk for cardiovascular disease (CVD) and ACS, it is still unclear how the various bDMARDs compare with each other.

In an observational cohort study conducted between 2008 and 2017, researchers enrolled patients with RA from Denmark, Finland, Norway, and Sweden initiating treatment with bDMARDs. The 1-, 2-, and 5-year IRs for ACS were calculated and ACS incidence across treatments, including ACS risk factors, were compared.

Subgroups analyses by age, number of previous bDMARDs, and history of CVD were also performed. In addition, ACS incidence rates were compared with an individually matched cohort from the general population.

Overall, 24,083 patients contributing to 40,850 treatment courses were included in the study. The mean age of patients was 56 years and 75% were women. During a maximum follow-up of 5 years representing 141,257 person-years (PY), a total of 780 ACS events occurred (crude incidence rate, 5.5 per 1000 PY). The overall incidence of ACS was approximately 80% higher for patients with RA compared with the general population.

Using etanercept as a reference, the researchers compared the risk for ACS across specific bDMARDs. They found that the hazard ratio (HR) for incident ACS was statistically significantly increased elevated crude hazard ratios (HRs) among patients receiving treatment with abatacept and rituximab, with HRs ranging between 1.1 and 1.3. The HRs for infliximab increased with increasing length of follow-up, reaching 1.49 (95% CI, 1.08-2.05) for the maximum follow-up period. The HRs for all other bDMARDs (adalimumab, certolizumab pegol, golimumab, and tocilizumab) were approximately 1.

Study limitations included lack of socioeconomic data, information on concomitant nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors, and data that could allow for meaningful comparisons of ACS risk in patients who received treatment with targeted synthetic DMARDs. In addition, the patient population included for comparison represented a specific subset of individuals with RA.

Researchers concluded, “… our results suggest that in RA treated with bDMARDs, the bDMARD used does not seem to matter for the risk of ACS.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Delcoigne B, Ljung L, Provan SA, et al. Short-term, intermediate-term and long-term risks of acute coronary syndrome in cohorts of patients with RA starting biologic DMARDs: results from four Nordic countries. Ann Rheum Dis. Published online March 22, 2022. doi:10.1136/annrheumdis-2021-221996