Cardiovascular Benefits of Maintaining Biologic Therapy Save

An Australian prospective study of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) has shown that sustained use of tumour necrosis factor (TNFi) inhibitors or biologics can reduce the risks of cardiovascular events (CVEs).

Studies have shown that the risk of major cardiovascular events (MACE) is elevated and not significantly different between RA and AxSpa or PsA (http://bit.ly/2MoHFNs).

A total of 4140 consecutive patients from the Australian Rheumatology Association Database with RA, PsA and AS, were followed between September 2001 to January 2015 and were included in the study.

An analysis of 19,627 patient-years showed that (after multivariate adjustment) the CVE risk was lower with TNFI (HR 0.85, 95% CI 0.76–0.95) and other biologic therapies (HR 0.81, 95% CI 0.70–0.95), but not in those who had stopped their biologic agents (HR 0.96, 95% CI 0.83–1.11). CVE risk was the same between RA, PsA and AS patients. 

These studies are similar to other showing the protective CV benefits of sustained therapy with either methotrexate or TNFi. 

This is important as a recent claims database study of 10,254 patients with RA, PsA, or Psoriasis seen between 2006-2015 showed that after initial CV event 15.3% discontinued and 15.5% switched DMARD therapy after index CV event. Independent predictors of DMARD discontinuation included PsO diagnosis, renal disease, hypertension, heart failure, diabetes mellitus, older age, and baseline csDMARD or non-TNFi bDMARD use (vs TNFi bDMARDs).  (http://bit.ly/2nzKeOs)

In their study, having RA and heart failure at baseline, but not DMARD use after index event, were independently associated with increased risk of a subsequent CV event.