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Tocilizumab Equals other Biologics in Cardiovascular Risk

An odd side effect of several new agents is the risk of hyperlipidemia.  While this has been seen with tocilizumab (TCZ), there does not appear to be a resultant risk of cardiovascular (CV) events.  A study of claims data compared CV risk in rheumatoid arthritis (RA) patients receiving TOC (an IL6 receptor antagonists) and other biologics and found no differences with regard to CV outcomes.

Xie et al, performed a cohort analysis using  Medicare and MarketScan claims data on RA patients who initiated biologic therapies between 2006 and 2-15, looking for specific CV outcomes including myocardial infarction, stroke, and fatal CVD, 

From 88,463 RA patients they calculated the risk of CV events (crude incidence rate (IR) per 1000 patient‐years to range from 11.8 for etanercept to 17.3 for rituximab users. The crude incidence rate for pooled TNFi users was 15.0 (13.9‐16.3).

When compared to tocilizumab, the adjusted hazard ratios for CV events with biologics were:

  • Abatacept 1.01 (0. 79‐1.28)
  • Rituximab 1.16 (0.89‐1.53)
  • Etanercept 1.10 (0.80‐1.51)
  • Adalimumab 1.33 (0.99‐1.80)
  • Infliximab 1.61 (1.22‐2.12) for infliximab.

The data were similar using Marketscan data showing were no statistically significant differences in CVD risk between tocilizumab and any other biologics

Tocilizumab was associated with CVD risk comparable to etanercept, as well as a number of other RA biologics.

The author has received compensation as an advisor or consultant on this subject

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