Background/Purpose: Rheumatoid Arthritis (RA) is a chronic autoimmune disease that is characterised by inflammation in the synovium of diarthrodial joints and low-level inflammation in multiple organ systems. It is associated with an increased risk of developing multiple systemic comorbidities, including cardiovascular disease (CVD), and RA patients with comorbid CVD exhibit a higher incidence of CV events and have increased mortality compared to patients with CVD alone. Reductions in disease activity lead to fewer CV events, and controlling disease activity is integral to managing CVD in RA. However, the impact of comorbid CVD disease on RA related outcomes has not been investigated relative to specific DMARD treatments. The aim of this study was to determine whether CVD was associated with outcomes in patients undergoing treatment with baricitinib and conventional synthetic DMARDs (csDMARDs).

Methods: Data were pooled from four randomised controlled clinical trials which compared the efficacy of baricitinib and/or csDMARDs in patients with moderate to severe RA. Patients were classified as having CVD if a diagnosis was present at baseline. Remission was defined as a clinical disease activity index (CDAI) ≤ 2.8. The association between a baseline diagnosis of CVD and the time to reach remission was analysed using Kaplan-Meier plots and Cox proportional hazard analysis. Multivariable models were adjusted using sex, age, weight, ethnicity, number of previous DMARDs trialled, rheumatoid factor status and stratified by actual treatment arm, clinical trial and CDAI category at baseline.

Results: Pooled data were available from 3100 patients, 1717 of whom were treated with baricintib ± csDMARDs, 1101 were treated with csDMARDs alone and 330 treated with adalimumab + csDMARDs. A total of 134 patients had comorbid CVD. Mean baseline disease activity (as measured by CDAI) for patients with CVD was 39.2 and 38.4 for patients without CVD. CVD was significantly associated with remission on univariable (Hazard Ratio = 0.56, 95% confidence interval [0.36 – 0.88], p = 0.01) and multivariable analysis (HR = 0.54 [0.34 – 0.87], p = 0.01). In patients treated with baricitinib, the effect size describing the association between baseline CVD and RA remission (HR = 0.42 [0.23 – 0.77], p = 0.005) was greater than that observed for csDMARDs alone (HR = 0.60 [0.15 – 2.5], p = 0.48), however the test for heterogeneity did not reach statistical significance (p = 0.15).

Conclusion: Comorbid CVD was associated with less frequent remission in patients with moderate to severe RA, particularly in patients undergoing treatment with the targeted synthetic DMARD baricitinib.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-of-cardiovascular-comorbidities-with-remission-in-rheumatoid-arthritis-patients-undergoing-treatment-with-baricitinib-and-conventional-synthetic-dmards-a-post-hoc-analysis/