TARGET Trial - Cardiovascular Risk Reduction in Rheumatoid Arthritis Save

A recent randomised clinical trial suggests immunomodulators reduce arterial inflammation, and thereby cardiovascular (CV) risk, but shows no significant benefit to TNF inhibitors over triple therapy in patients with rheumatoid arthritis (RA).

The TARGET (The Treatments Against RA and Effect on FDG-PET/CT) trial enrolled adult patients with active RA (despite methotrexate) and randomized them to receive either a tumour necrosis factor (TNF) inhibitor (TNFi) or addition of sulfasalazine and hydroxychloroquine (triple therapy) for 24 weeks. The primary endpoint was arterial inflammation as assessed by 18F-fluorodeoxyglucose-positron emission tomography/CT scans, measuring arterial target-to-background ratio (TBR) in the carotid arteries and aorta.

A total of 159 patients were randomisedl 138 completed follow-up and 115 patients completed the protocol. Both treatment groups were clinically balanced with a baseline DAS28 of 4.8 (IQR 4.0, 5.6). Both treatment grous demonstrated significant TBR reductions —ΔTNFi: −0.24 (SD=0.51), Δtriple therapy: −0.19 (SD=0.51)— with no significant differences between groups (p=0.79) and no significant TBR differences related to clinical improvement.

Conclusion We found that addition of either a TNFi or triple therapy resulted in clinically important improvements in vascular inflammation. However, the addition of a TNFi did not reduce arterial inflammation more than triple therapy.

Both TNF inhibitors and triple therapy can significantly reduce disease activity and cardiac inflammation and it is unclear if these different treatments impact arterial inflammation differently.