NEW YORK (Reuters Health)—The newer disease-modifying drugs for rheumatoid arthritis appear to offer the same or even better cardiovascular (CV) protection than older tumor necrosis factor (TNF) inhibitors, hints a large study.
“We really haven’t had a good understanding on where the non-TNF biologics and CV risk stand,” Dr. Jeffrey R. Curtis of the University of Alabama at Birmingham told Reuters Health in a telephone interview. “These newer drugs are no worse, possibly a tad better than the older ones.”
Dr. Curtis and colleagues compared cardiovascular risks and outcomes among 47,193 Medicare beneficiaries with rheumatoid arthritis by type of biologic used for RA.
Using a retrospective cohort design and multivariable regression, investigators analyzed medical and pharmacy claims between 2006 and 2012. All patients had started a biologic during the study period, had no coronary disease at baseline, and had Medicare medical and drug benefits for at least 12 months prior to starting a biologic.
Acute myocardial infarction (AMI) and a composite of AMI or coronary revascularization were primary outcomes.
Overall, crude incidence rates for AMI were low, ranging from 5.7 to 8.8 per 1,000 person-years, according to an article online on Jan. 20 in Annals of the Rheumatic Diseases.
AMI risk was significantly elevated among patients starting TNF-inhibitor therapy overall (adjusted hazard ratio 1.3) and individually among those starting etanercept or infliximab (both aHR 1.3) compared with patients initiating abatacept.
Tocilizumab was tied to a reduced risk of the composite outcome (aHR 0.64) compared to abatacept. “Perhaps the most useful finding is that tocilizumab didn’t increase risk for cardiovascular disease,” Dr. Curtis said.
Looking at the big picture, Dr. Curtis stressed that the “magnitude of risk is pretty tiny” for any of these drugs, and that this paper would not alter prescribing patterns. Overall, the comparative analysis is “reassuring,” he said.
Dr. Daniel Solomon of Boston’s Brigham and Women’s Hospital and Harvard Medical School also called the study “reassuring” in a phone interview with Reuters Health. “It’s a relatively well done study with a large population and good methodologic outcomes,” he said. “Overall, there are no important differences. It’s a very useful set of new information with a broad range of disease modifying drugs not included before.”
The researchers reported no funding.