Patients With Rheumatoid Arthritis With an Inadequate Response to Disease‐Modifying Antirheumatic Drugs at a Higher Risk of Acute Coronary Syndrome

Abstract

Background Cardiovascular disease is the most common cause of death in patients with rheumatoid arthritis. It is believed that using disease‐modifying antirheumatic drugs (DMARDs) to control inflammation can reduce the risk of cardiovascular disease. In this study, we investigated whether patients who responded differently to DMARDs might sustain different cardiovascular events. Methods and Results We designed a cohort study using the Chang Gung Research Database. We identified 7114 patients diagnosed with rheumatoid arthritis. After strict exclusion criteria, we collected 663 individuals as an inadequate response to DMARDs group. Then, 2034 individuals were included as the control group. The end point was composite vascular outcomes, including acute coronary syndrome or ischemic stroke. We used the inverse probability of treatment weighting to keep the covariates between these 2 groups well balanced. We compared the risk of these outcomes using the Cox proportional hazards model. The mean follow‐up time was 4.7 years. During follow‐up, there were 7.5% and 6.4% of patients with composite vascular outcomes in the DMARD‐inadequate response and control groups, respectively. There was no significant difference in the risk of composite vascular outcomes (95% CI, 0.94–1.41) and ischemic stroke (95% CI, 0.84–1.36). The risk of acute coronary syndrome was significantly higher in the DMARD‐inadequate response group (hazard ratio, 1.45; 95% CI, 1.02–2.05). Conclusions Patients with DMARD‐inadequate response rheumatoid arthritis have a higher risk of developing acute coronary syndrome than those whose disease can be controlled by DMARDs.

Short-term, intermediate-term and long-term risks of acute coronary syndrome in cohorts of patients with RA starting biologic DMARDs: results from four Nordic countries

“…Most studies focusing on the association between treatment and CV risk have compared groups of drugs rather than individual ones, at least with regard to TNFis. Compared with non-bDMARDs, TNFis have a positive effect on the risk of CV events,10 11 20 37–39 in particular among responders;39–41 tocilizumab has been reported to exert marginally superior effects on CV outcomes compared with TNFis,10 12 13 but results are conflicting 25 42–44. No detrimental effect on CV outcomes of abatacept or rituximab have been reported 12 13 42.…”

Clinical outcomes and prognostic factors of bronchiectasis rheumatoid overlap syndrome: A multi-institution cohort study

“…BROS was defined as a diagnosis of RA—made either before or after the diagnosis of bronchiectasis—in the bronchiectasis cohort ( 7 ). The diagnosis of RA was identified using ICD-9-CM code 714.0 or ICD-10-CM code M05.70–M06.09, M06.20–M06.39, M06.80–M06.89, or M06.9 ( 17 , 18 ). The Institutional Review Board of Chang Gung Memorial Hospital approved this study (IRB number: 201800712B0C502).…”

Chronic rheumatologic disorders and cardiovascular disease risk in women

“…Methotrexate and other disease-modifying antirheumatic drugs (DMARDS) reduce atherosclerosis and decrease the risk of CVD events in patients with RA [33] . Patients with inadequate response to DMARDS have a higher risk of developing acute coronary syndrome than those with RA controlled by DMARDS [34] . Despite its limited efficacy for RA activity and progression, hydroxychloroquine has been shown to improve metabolic profile and to a lesser extent cardiovascular events, and may be considered in combination with other DMARDS [35] .…”