Background/Purpose:

People with RA have a higher risk for developing cardiovascular diseases than the general population. The pathogenic mechanisms in RA appear to be complex and multifactorial.

1. To assess the effect of Biologic Disease Modifier Anti-Rheumatic Drugs (BDMARDs) on a 10-year CV event risk in patients with RA after 2 years of follow-up

2. To evaluate the impact of BDMARDs on the incidence of CV events in patients with RA

Methods:

Patients with RA receiving biologic therapy were prospectively followed-up. The FRS was used for the assessment of 10-year CVD risk. The presence of CV risk factors was ascertained at the baseline and at every six months of observation up to 24 months. Analyses of the relationships between lipids and inflammatory indices before and after treatment with biologics were performed. Ten-year CVD event risk was assessed by gender and age.

Results:

From 228 patients, 2 patients passed away and 6 patients dropped out of the study. Total 220 patients (73% females) with the mean (SD) age of 56.2 (11.6) years were prospectively followed up to 24 months. The mean (SD) age at RA diagnosis was 41.6 (12.9) years with the mean (SD) duration of RA symptoms 14.5 (8.5) years. Nine patients with documented MI and 5 patients with TIA/Stroke had CV events prior to the study. Two male patients had MI during the observation period. Forty-two patients (62% females) smoked at the baseline. Sixty-five patients were on Lipid-lowering treatment, of them 48% started it after the initiation of the treatment with biologics.  

TJC and SJC were significantly reduced after 24 months of treatment. TC did not change significantly after 1 year but was significantly reduced after 2 years.  HDL increased significantly at 12-month and then significantly reduced at 24-month period. Comparison of LDL measurements at 12 and 24-month periods showed significant improvement from 1.8±1.6 to 1.3±1.5 with p<0.001. The AI was significantly reduced during the two follow-up periods. CRP, ESR and DAS28 were also significantly reduced from the baseline levels (Table).

RA Characteristics	Baseline, mean (SD)	12-month F-Up, mean (SD)	P	24-month F-Up, mean (SD)	P
Total Joint Count (TJC)	12.3 (8.1)	5.3 (4.7)	<0.001	5.1 (5.6)	<0.001
Swollen Joint Count (SJC)	4.3 (3.7)	2.1 (2.6)	<0.001	1.1 (1.9)	<0.001
C-Reactive Protein (CRP), mg/l	15.5 (29.0)	10.1 (15.5)	0.004	4.7 (8.3)	<0.001
ESR, mm/h	29.7 (22.8)	22.9 (20.1)	<0.001	16.4 (17.7)	<0.001
DAS28 score	4.1 (1.2)	3.6 (1.2)	<0.001	3.0 (1.1)	<0.001
CDAI score	18.2 (9.6)	14.2 (9.8)	<0.001	10.7 (7.2)	<0.001
HAQ score	1.2 (0.7)	1.1 (0.7)	0.030	0.9 (0.7)	<0.001
Total Cholesterol, mmol/l	3.0 (2.8)	3.3 (2.7)	0.038	2.0 (2.5)	<0.001
HDL Cholesterol, mmol/l	0.7 (0.7)	0.8 (0.7)	0.001	0.6 (0.7)	0.025
Atherogenic Index (TC/HDL)	4.6 (1.7)	4.1 (1.2)	<0.001	3.8 (0.8)	<0.001
Overall 10-year CV Event Risk (%)	12.5 (9.3)	12.1 (9.0)	0.019	11.9 (8.9)	<0.001

The overall risk of cardiovascular event significantly reduced in 12 months (p=0.019, 95%CI 0.1-0.7) and 24 months of the study (p<0.001; 95%CI 0.3-0.9). Thirty seven patients switched biologics during their treatment course. The analysis of the impact of individual biologic DMARD on 10-year CV event risk showed significant improvement at 24-month period in Tocilizumab (p=0.002) and Abatacept (p=0.042) groups.

Conclusion:

Our results showed a trend in reducing a 10-year CV event risk in RA patients treated with BDMARDs. This improvement was influenced by many factors. The study results demonstrated a possible favorable effect of biologic DMARDs on the serum levels of TC, LDL and AI. Good control of the inflammation by BDMARDs effectively decreased inflammation and possibly played a pivotal role in reducing the risk for cardiovascular event in patients with RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-biologic-disease-modifiers-on-cardiovascular-risk-of-patients-with-rheumatoid-arthritis-2-years-prospective-cohort-study/