Background/Purpose: Patients with psoriatic arthritis (PsA) are at increased risk for cardiovascular (CV) events, but different treatment options may not have the same rates of CV events (Jamnitski et al. Ann Rheum Dis. 2013;72:211-6; Ogdie et al. Curr Opin Rheumatol. 2015;27:118-26). This study compared rates of myocardial infarction (MI), stroke, and revascularization by treatment type in patients with PsA.

Methods: We conducted a population-based cohort study of treated PsA patients in the MarketScan database from 2014 to 2016. The cohort entry was the date of the first prescription for a study drug (apremilast [APR] only or in combination with ≥1 other study drugs, anti-TNF-α biologics only, other biologics and DMARDs [OBDs] only, corticosteroids only, OBDs + corticosteroids, and anti-TNF-α biologics with OBDs and/or corticosteroids) after March 21, 2014, the date on which APR was approved. Patients were followed from cohort entry through the censor date, defined as the first of the following: the index date (date patient became a case), end of record, or end of study period (December 31, 2016). MI and stroke cases required 1 inpatient diagnosis plus 2 additional diagnoses on separate days; revascularization required a procedure code for revascularization without MI or stroke, all ≥7 days after cohort entry. A patient was considered currently exposed from the prescription date through the prescription duration + 30 days. We calculated incidence rates (IRs) and 95% CIs for each outcome per 100 patient-years among the entire population and in the subgroup of patients with no history of serious CV disease (CVD).

Results: The study population included 51,971 patients (median age: 52 years; female: 52%; serious CVD history: 4.0%). IRs were low for all outcomes, and between-treatment differences did not reach statistical significance (95% CIs for IRs were overlapping). Among the 187 MI cases, IRs (95% CIs) were as follows: for APR only, 0.10 (0.01, 0.35), or in combination, 0.49 (0.20, 1.02); anti-TNF-α biologics only, 0.13 (0.09, 0.19); anti-TNF-α biologics with OBDs and/or corticosteroids, 0.31 (0.22, 0.43); OBDs only, 0.32 (0.23, 0.44); corticosteroids only, 0.44 (0.27, 0.68); and OBDs + corticosteroids, 0.45 (0.24, 0.76). Among the 79 stroke cases, IRs (95% CIs) were as follows: for corticosteroids only, 0.08 (0.02, 0.22); anti-TNF-α biologics only, 0.09 (0.06, 0.13); for OBDs only, 0.10 (0.05, 0.17); anti-TNF-α biologics with OBDs and/or corticosteroids, 0.12 (0.06, 0.20); APR only, 0.15 (0.03, 0.43), or in combination, 0.14 (0.02, 0.51); and OBDs + corticosteroids, 0.21 (0.08, 0.45). Among the 292 revascularization cases, IRs (95% CIs) were as follows: for APR only, 0.25 (0.08, 0.57), or in combination, 0.42 (0.15, 0.92); anti-TNF-α biologics only, 0.36 (0.29, 0.44); anti-TNF-α biologics with OBDs and/or corticosteroids, 0.37 (0.27, 0.50); OBDs + corticosteroids, 0.38 (0.19, 0.68); OBDs only, 0.48 (0.36, 0.61); and corticosteroids only, 0.49 (0.31, 0.73). Among patients with no serious CVD history, IRs were generally lower but results were not materially different from the main analyses.

Conclusion: Rates of MI, stroke, and revascularization were low for treated PsA patients and were similar across treatments.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rates-of-myocardial-infarction-stroke-and-revascularization-among-patients-with-psoriatic-arthritis-treated-with-apremilast-biologics-dmards-and-corticosteroids-in-the-us-marketscan-database/