Tocilizumab Cardiovascular Risk in Rheumatoid Arthritis

LDL particles in the blood stream
LDL particles in the blood stream
Cohort study of patients with rheumatoid arthritis who newly initiated tocilizumab or tumor necrosis factor inhibitor therapy using multi-database claims data.

Findings from a population-based cohort study in Arthritis & Rheumatology show no evidence of a higher cardiovascular (CV) risk among patients with rheumatoid arthritis (RA) who switch from a different biologic drug or tofacitinib to tocilizumab vs. to a tumor necrosis factor inhibitor (TNFi). 

Tocilizumab, an interlekin-6 antagonist, is known to raise LDL cholesterol levels but it is unclear whether the drug raises CV risk in patients with RA. Study authors from the Brigham and Women’s Hospital in Boston and Genentech in San Francisco aimed to compare cardiovascular safety by conducting a cohort study of patients with RA who newly initiated tocilizumab or TNFi using multi-database claims data. 

Patients included in the study were required to have previously used a different TNFi, abatacept, or tofacitinib. The primary outcome was the composite cardiovascular endpoint of hospitalization for myocardial infarction (MI) or stroke. 

A total of 9,218 patients started on tocilizumab were propensity score matched to 18,810 TNFi starters. Baseline cardiovascular disease was observed in 14.3% of tocilizumab patients and 13.5% of TNFi patients. During the study, 125 composite cardiovascular events occurred resulting in an incidence rate of 0.52 per 100 person-years among tocilizumab initiators vs. 0.59 per 100 person-years among TNFi initiators. 

Study authors concluded that the risk of cardiovascular events associated with tocilizumab use vs. TNFi was similar across all three databases analyzed (combined hazard ratio [HR] 0.84, 95% CI: 0.56–1.26). 

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Kim SC, Solomon DH, Rogers JR, et al. Cardiovascular safety of tocilizumab versus tumor necrosis factor inhibitors in patients with rheumatoid arthritis – a multi-database cohort study [published online February 28, 2017]. Arthritis Rheumatol. doi:10.1002/art.40084

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This article originally appeared on MPR