CV Risk Decreased with Certain DMARDs in Rheumatoid Arthritis Save

A large prospective cohort study examined the comparative risks of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) and found that, methotrexate (MTX), abatacept (ABA) and TNF inhibitor (TNFi) use were associated with a decreased risk of CV events. 

RA patients in the FORWARD study (1998 through 2017) were assessed for incident CVD events (myocardial infarction, stroke, heart failure, and CVD-related death) based on whether they were taking (1) conventional synthetic DMARD (csDMARD; referent; (2) TNFi; (3) ABA; (4) rituximab; (5) tocilizumab; (6) anakinra; (7) tofacitinib or glucocorticoids (GC). 

From a total of 18,754 RA patients, followed a median of 4.0 (1.7–8.0) years,  there were 1801 CVD events.

Compared to csDMARD use, CVD risk reduction was seen with:

• TNFi (HR 0.81, 95% CI 0.71–0.93)
• ABA (HR 0.50, 95% CI 0.30–0.83) 
• MTX  use was associated with a lower CVD risk [use vs nonuse HR 0.82, 95% CI 0.74–0.90)
• GC exposure was associated with increased CVD risk (HR 1.15, 95% CI 1.11–1.19)

Prior studies have shown the CV benefits for MTX and TNFi; now ABA can be added to this list. These data also underscore the need to minimize GC use while optimizing MTX dose.