TNF Inhibitors May Increase Cardiac Risks in Elderly Save

A retrospective study of elderly rheumatoid arthritis (RA) patients on Medicare was conducted by a group of researchers from the University of Alabama. They aimed to compare the coronary heart disease risk among RA patients initiating biologic disease-modifying anti-rheumatic drugs of different mechanisms between 2006-1012. (Citation source http://buff.ly/1PJDemH)

The investigators compared the incidence rates of acute myocardial infarction (AMI) in the cohort of 47,193 eligible patients with RA and mean age 64 years. All patients enrolled in the study had no prior history of coronary heart disease and were initiated on a biologic to be entered into the analysis. 

The study concluded that AMI risk was significantly elevated among those receiving anti-tumour necrosis factor (anti-TNF) initiators overall (adjusted HR 1.3; 95% CI 1.0 to 1.6) when compared with abatacept and tocilizumab. Within the TNFi group, highest risk was seen with etanercept (aHR 1.3; 95% CI 1.0 to 1.8) and infliximab (aHR 1.3; 95% CI 1.0 to 1.6) compared to those on abatacept.  

Previously anti-TNF agents have been shown to lower cardiovascular event risk. But these data suggest that maybe elderly patients would have less CV events if placed on non-TNF biologic therapy.