ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2284

Cardiovascular Outcomes in Diabetic Rheumatoid Arthritis Patients: TNF-α Inhibitors versus IL-6 Inhibitors

Sila Mateo Faxas1, Godbless Ajenaghughrure1, Gurjot Singh2, Kim Nguyen2, Nirys Mateo Faxas3, Nicole Tejeda4, Kimberly Ramirez Bonetti5 and Erick Perez Mejias4, 1Trihealth Good Samaritan Hospital, Cincinnati, OH, 2Trihealth Good Samaritan Hospital, Cincinnati, 3Independent Author, Santo Domingo, Dominican Republic, 4Independent Author, Cincinnati, 5Independent 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: Patients with rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM) face increased cardiovascular risk. Different biologic disease-modifying antirheumatic drugs (bDMARDs) may have varying effects on cardiovascular outcomes in this high-risk population. This study compared cardiovascular outcomes between RA patients with T2DM treated with IL-6 inhibitors (IL-6i) versus TNF-α inhibitors (TNFi).

Methods: Using the TriNetX global federated health research network, we conducted a retrospective cohort study of adult patients with RA and T2DM. Patients were divided into two cohorts: those receiving IL-6i (sarilumab or tocilizumab) without TNFi (n=1,579) and those receiving TNFi without IL-6i (n=1,579), matched using propensity score on 20+ potential confounders. Outcomes included mortality, major adverse cardiovascular events (MACE), arrhythmias, heart failure, and other cardiovascular conditions over a 5-year follow-up period.

Results: IL-6i-treated patients demonstrated significantly higher risk for mortality (HR=1.626, 95% CI: 1.308-2.021, p< 0.001), acute kidney failure (HR=1.772, 95% CI: 1.420-2.212, p< 0.001), and heart failure (HR=1.399, 95% CI: 1.193-1.640, p< 0.001) compared to TNFi-treated patients. Additionally, IL-6i recipients had higher risk for ventricular arrhythmias (HR=1.459, 95% CI: 1.006-2.175, p=0.045), pulmonary embolism (HR=2.092, 95% CI: 1.420-3.081, p< 0.001), and infections/inflammatory reactions related to cardiac devices (HR=3.485, 95% CI: 1.122-10.821, p=0.021). However, TNFi-treated patients had significantly higher frequency of diabetes-related follow-up visits (17.46 vs 14.69 visits, p=0.004).

Conclusion: In this propensity-matched analysis of RA patients with T2DM, treatment with IL-6i was associated with significantly higher risk of mortality and multiple cardiovascular adverse events compared to TNFi treatment. While both drug classes effectively manage RA symptoms, our findings suggest TNFi may be preferable for this specific patient population from a cardiovascular safety perspective. These results highlight the importance of considering cardiovascular risk profiles when selecting biologic therapy for RA patients with comorbid T2DM.

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; E. Perez Mejias: 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, Perez Mejias E. Cardiovascular Outcomes in Diabetic Rheumatoid Arthritis Patients: TNF-α Inhibitors versus IL-6 Inhibitors [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/cardiovascular-outcomes-in-diabetic-rheumatoid-arthritis-patients-tnf-%ce%b1-inhibitors-versus-il-6-inhibitors/. Accessed .

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