ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2283

Arrhythmia Risk in Diabetic Rheumatoid Arthritis Patients: Comparative Analysis of IL-6 Inhibitors versus TNF-α Inhibitors

Sila Mateo Faxas1, Godbless Ajenaghughrure2, Gurjot Singh3, Kim Nguyen3, Nirys Mateo Faxas4, Nicole Tejeda5 and Kimberly Ramirez Bonetti6, 1Good Samaritan Hospital, Cincinnati, OH, 2Trihealth Good Samaritan Hospital, Cincinnati, OH, 3Trihealth Good Samaritan Hospital, Cincinnati, 4Independent Author, Santo Domingo, Dominican Republic, 5Independent Author, Cincinnati, 6Independent Author, cincinnati, OH

Meeting: ACR Convergence 2025

Keywords:

Session Information

Date: Tuesday, October 28, 2025

Title: (2265–2289) Rheumatoid Arthritis – Treatment Poster III

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: Background: Both rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM) are independently associated with increased cardiovascular risk, including cardiac arrhythmias. The impact of different biologic therapies on arrhythmia risk in patients with both conditions remains unclear. This study evaluates arrhythmia outcomes in RA patients with T2DM treated with IL-6 inhibitors (IL-6i) versus TNF-α inhibitors (TNFi).

Methods:

Methods: We conducted a retrospective cohort study using TriNetX, a global federated health research network. Adult patients with RA and T2DM receiving either IL-6i (sarilumab/tocilizumab) without TNFi or TNFi without IL-6i were identified. After propensity score matching (n=1,579 per cohort), we compared the incidence of various arrhythmias including atrial fibrillation, ventricular tachycardia, ventricular fibrillation, supraventricular tachycardia, and sick sinus syndrome over a 5-year follow-up period.

Results:

Results: IL-6i treatment was associated with significantly higher risk of ventricular tachycardia compared to TNFi (HR=1.419, 95% CI: 1.006-2.002, p=0.045). Though not statistically significant, there were trends toward increased risk with IL-6i for atrial fibrillation (HR=1.104, 95% CI: 0.894-1.365, p=0.357), supraventricular tachycardia (HR=1.138, 95% CI: 0.767-1.688, p=0.521), and ventricular fibrillation (HR=1.628, 95% CI: 0.964-2.747, p=0.066). Notably, the need for pacemaker implantation was higher in the IL-6i group (HR=1.394, 95% CI: 1.006-1.933, p=0.045). The 5-year arrhythmia-free survival rate was lower in IL-6i-treated patients compared to TNFi-treated patients (p < 0.05).

Conclusion: Conclusions: In RA patients with comorbid T2DM, treatment with IL-6i was associated with higher risk of cardiac arrhythmias, particularly ventricular tachycardia, compared to TNFi therapy. These findings suggest that TNFi may offer a more favorable cardiac safety profile in this high-risk population. Clinicians should consider arrhythmia risk when selecting biologic therapy for patients with both RA and T2DM, and closer cardiac monitoring may be warranted for those receiving IL-6i.

Disclosures: S. Mateo Faxas: None; G. Ajenaghughrure: None; G. Singh: None; K. Nguyen: None; N. Mateo Faxas: None; N. Tejeda: None; K. Ramirez Bonetti: None.

To cite this abstract in AMA style:

Mateo Faxas S, Ajenaghughrure G, Singh G, Nguyen K, Mateo Faxas N, Tejeda N, Ramirez Bonetti K. Arrhythmia Risk in Diabetic Rheumatoid Arthritis Patients: Comparative Analysis of IL-6 Inhibitors versus TNF-α Inhibitors [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/arrhythmia-risk-in-diabetic-rheumatoid-arthritis-patients-comparative-analysis-of-il-6-inhibitors-versus-tnf-%ce%b1-inhibitors/. Accessed .

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