A pair of studies presented at the 2013 ACR/ARHP Annual Meeting in San Diego might provide an important link in the chain of evidence that anti-tumor necrosis factor (TNF) agents may act as cardioprotective agents for rheumatoid arthritis (RA) patients.
One of the reports, “Tumour Necrosis Factor Inhibitors and the Risk of Acute Coronary Syndrome in Rheumatoid Arthritis—a National Cohort Study” (Abstract #804) surveyed associations with different treatments in 30,000 RA patients in Sweden, as well as patients with other diagnoses. Although RA was confirmed to be associated with more than a two-fold risk of developing an “acute coronary syndrome,” treatment of RA patients with a TNF inhibitor showed a more than 20% reduction in development of acute heart disease.
The other study, “Incidence and Severity of Myocardial Infarction in Subjects Receiving Anti Tumour Necrosis Factor Drugs for Rheumatoid Arthritis” (Abstract #2760) cross-referenced nearly 15,000 RA patients in the British Society for Rheumatology Biologics Register for RA and Myocardial Ischaemia National Audit Project. Researchers found that, compared with RA patients on methotrexate or other nonbiologic agents, patients on TNF inhibitor treatment had a rate of MI occurrence decreased by nearly 40%. It also showed no difference in the size of the MI or for MIs resulting in death.
“This is especially interesting, as in earlier studies there was concern that TNF blockers could adversely affect cardiac output and function in a compromised heart,” says Gregg J. Silverman, MD, professor of medicine and pathology and co-director of the Musculoskeletal Center of Excellence at NYU Langone Medical Center in New York City. “Better control of RA disease activity may also help protect from cardiac complications. Benefits from biologic agents may extend beyond protection from progressive joint destruction, and may even enhance long-term survival.”
The results offer rheumatologists additional evidence to support decisions to start a TNF blocker in at-risk RA patients, and could “motivate patients to pursue more aggressive and potent RA treatment,” Dr. Silverman adds.
Richard Quinn is a freelance writer in New Jersey.