Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
reported that TNF-inhibitors (TNF-Is) are associated with a
reduced risk of cardiovascular (CV)
events,1 but data on their effects on traditional CV risk factors in
clinical practice are limited.
The objective of this analysis was to evaluate mean changes from baseline (CFB)
in CV risk factors of blood
pressure (BP), lipids, hemoglobin A1c (A1c) and CRP among
adult RA patients (pts) prescribed first bDMARDs. A secondary objective was to
compare mean CFB in CV risk factors in pts prescribed abatacept (ABA) vs TNF-Is
and other non-TNF-Is (excluding ABA).
Centricity® data, a nationally representative electronic database of >17 million de-identified medical records.
Inclusion criteria were: ≥1 RA diagnosis code (January 2000–February
2014), aged ≥18 yrs at diagnosis, received a
prescription for a bDMARD (index bDMARD), no bDMARD prescription during
baseline (12 months prior to index bDMARD), ≥1 CV risk factor measured during the baseline period and 1 during
follow-up, and receiving index bDMARD during 12-month follow-up. Lab values closest to the 12-month interval in a +/- 6-month window were
used to calculate CFB. CFB in CV risk factors were described using mean,
variance and SEs. Regression analyses were conducted for CFB in CV risk factors
as dependent variables, and baseline covariates of demographics, co-morbidities,
treatments to manage CV risk factors and RA treatments as independent variables.
Sensitivity analyses were conducted to assess changes in CV risk factors among
pts who had treatment changes for BP, lipids and diabetes.
included in the analysis. Mean (SD) age: 53.8 (13.5) yrs; 75.6% female; 6.5%
had a CV event during baseline. Mean (SE; p-value) CFB were: systolic BP –0.50 mm
Hg (0.165; 0.002); diastolic BP –0.28 mm Hg (0.103; 0.006); low-density
lipoprotein (LDL) –2.42 mg/dL (0.81; 0.003); high-density lipoprotein (HDL)
0.23 mg/dL (0.27; 0.402); total cholesterol (TC) –1.87 mg/dL (0.83; 0.024);
triglycerides –0.23 mg/dL (1.36; 0.864); A1c 0.01% (0.04; 0.767); CRP –0.61 mg/dl
(0.099; <0.0001). Most (69%) pts did not have treatment for CV risk factors
at baseline or follow-up; within this untreated subgroup, the CFB in CV risk
factors were only statistically significant for HDL and CRP. Beta coefficients
of the regression analysis for CFB in CV risk factors between pts prescribed
ABA vs TNF-Is and ABA vs non-TNF-Is are shown in the Table; none were significant
at an alpha level of 0.05.
Conclusion:
Though we observed that CV risk
factors of BP, lipids (LDL-cholesterol and TC) and CRP levels were
significantly reduced in RA pts prescribed bDMARDs, these reductions (except
CRP) are likely driven by treatment for CV risk factors. There were no
differences in changes in CV risk factor levels between pts prescribed abatacept
and those prescribed TNF-Is or other non-TNF-Is.
1.
Solomon
DH, et al. Am J Med 2013;126:730.e9-730.e17.
|
Table. Comparison of CV risk factor changes between ABA vs TNF-Is and ABA vs non-TNF-Is (excluding ABA) |
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|
*Non-TNF-Is (excluding ABA) vs ABA |
p-value comparing non-TNF-Is vs ABA |
*TNF-Is vs ABA
|
p-value comparing TNF-Is vs ABA |
|
|
Change in diastolic BP (mm Hg) |
(n=858) 0.2313 |
0.7663 |
(n=11,217) 0.0068 |
0.9890 |
|
Change in systolic BP (mm Hg) |
(n=859) –0.8450 |
0.4968 |
(n=11,224) –0.7392 |
0.3507 |
|
LDL-cholesterol (mg/dL) |
(n=135) –4.9075 |
0.3579 |
(n=1382) –1.9861 |
0.5859 |
|
HDL-cholesterol (mg/dL) |
(n=162) 0.5214 |
0.7770 |
(n=1706) –1.1205 |
0.3495 |
|
Total cholesterol (mg/dL) |
(n=151) –0.8647 |
0.8806 |
(n=1696) –2.2164 |
0.5535 |
|
Triglyceride (mg/dL) |
(n=161) –6.2453 |
0.4969 |
(n=1714) 1.6441 |
0.7855 |
|
A1c (%) |
(n=83) –0.3282 |
0.1997 |
(n=771) –0.1519 |
0.3590 |
|
CRP |
(n=246) –0.2444 |
0.7572 |
(n=3585) –0.3862 |
0.4403 |
|
*Regression coefficients, ABA is the reference group. A1c=hemoglobin A1c; ABA=abatacept; BP=blood pressure; CV=cardiovascular; HDL=high-density lipoprotein; LDL=low-density lipoprotein. |
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To cite this abstract in AMA style:
Alemao E, Simon T, Gandhi K, Kawabata H, Curtis JR. Evaluation of Changes in Cardiovascular Risk Factors Among Patients with RA Prescribed Biologic Dmards [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/evaluation-of-changes-in-cardiovascular-risk-factors-among-patients-with-ra-prescribed-biologic-dmards/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-changes-in-cardiovascular-risk-factors-among-patients-with-ra-prescribed-biologic-dmards/