Taking methotrexate or anti-TNFs is associated with a reduction in risk of cardiovascular disease in people with rheumatoid arthritis, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Chicago.
Methotrexate and anti-TNFs are among the most effective and commonly used treatments of inflammatory rheumatic diseases, such as rheumatoid arthritis. Previous studies have shown that these medications are associated with reducing the risk of coronary artery disease (called CAD; a disease that causes a narrowing of the blood vessels that supply the heart with oxygen) in people with RA, and researchers have recently looked at each medication individually to confirm this association.
Led by Rasa Bozaite-Gluosniene, MD, the research team identified 1,829 people from the U.S. with newly diagnosed RA (who did not have pre-existing CAD) between 2001 and 2009. Of this group, 1,119 were (at some point) taking methotrexate (Rheumatrex®, Trexall® ) and 710 were not; 588 were (at some point) taking anti-TNFs (Enbrel®, Humira®, and Remicade®) and 1,241 were not.
The researchers followed electronically each patient's exposure to the two medications to see if any developed CAD (which would have been identified by a billing code for disease diagnosis or a cardiac revascularization procedure). During this time, the researchers took into consideration other characteristics associated with risk of CAD, such as age, gender, blood pressure (including high blood pressure), cholesterol (both 'good' and 'bad'), diabetes, rheumatoid factor, body mass index, and use of other types of medications (such as statins, hydroxychloroquine, steroids or nonsteroidal anti-inflammatory drugs).
Dr. Bozaite-Gluosniene's team noted that those who took methotrexate or anti-TNFs developed fewer new cases of CAD than those who did not. In those taking methotrexate versus whose who weren't, the rate of new cases of CAD was 37.5 vs. 17.6 per 1,000 person-years of observation, respectively. Patients on methotrexate had 46 percent lower likelihood of CAD events than those not on methotrexate.
For methotrexate use that lasted more than 24 months, the risk of developing CAD was reduced by 67 percent as compared to those not taking methotrexate. In those taking anti-TNFs versus those who were not, the rate of new cases of CAD was 11.8 versus 32.1 per 1,000 person years. Overall, among those taking anti-TNFs there were 46 percent less likely to have a CAD event than patients not on anti TNFs. In participants taking anti-TNFs more than for more than 24 months, the likelihood of developing CAD was reduced by 76% as compared to those not taking it.
"RA is a systemic inflammatory condition with cardiovascular disease being the major cause of death," says Androniki Bili, MD, MPH; associate, Department of Rheumatology, Geisinger Medical Center, Danville, Pa. and an investigator in the study. "Medications that effectively control RA inflammation may be associated with reduction in cardiovascular risk."
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