Combination Treatments Improve CV Risk in Rheumatoid Arthritis

Researchers sought to determine if immunomodulators and related combination therapy strategies reduced cardiovascular risk and adverse events in patients with rheumatoid arthritis, citing large trials that found immunomodulators reduced cardiovascular events in the general public. The data were published in Annals of Rheumatic Diseases.

According to the study’s lead author, Daniel Solomon, methotrexate combined with either a tumor necrosis factor inhibitor (TNFi) or sulfasalazine plus hydroxychloroquine (triple therapy) yielded clinically meaningful improvements in cardiovascular inflammation.

Additional Treatments in Rheumatoid Arthritis Improve CV Risk

The randomized controlled trial enrolled 115 patients (71% female; median years of age, 58; 57% seropositive disease) with active rheumatoid arthritis despite methotrexate treatment to either TNFi or triple therapy.

Authors stated the two treatment groups were well balanced and had comparable baseline arterial inflammation, expressed as an arterial target-to-background ratio (TBR) in carotid arteries and aorta per 18F-fluorodeoxyglucose-positron emission tomography/CT imaging.  The cohort had baseline disease activity score over 28 joints of 4.8 (interquartile range, 4.0-5.6).

According to the authors, both the TNFi group and triple therapy group had significant reductions in TBR with changes of -0.24 ± 0.51 and -0.19 ± 0.51, respectively. The between-group difference was marginal at -0.02 (95% CI, -0.19 to 0.15; P=.79). In addition, researchers observed significantly reduced disease activity in both groups; however, this did not show any association with change in TBR (β=0.04; 95% CI, -0.03 to 0.10).

The study noted that the positive impact of immunomodulator therapy on cardiovascular risk among patients with rheumatoid arthritis was generally consistent with positive cardiovascular effects seen with immunomodulators in general populations.

Ultimately, among patients with active rheumatoid arthritis on methotrexate, “addition of either a TNFi or triple therapy resulted in clinically important improvements in vascular inflammation,” the authors summarized.

Related: Biomarkers for TNFi Response in Rheumatoid Arthritis