Tofacitinib Monotherapy Improves Left Ventricular Mass and Cardiac Output in Patients with Rheumatoid Arthritis

Kensuke Kume¹, Kanzo Amano², Susumu Yamada¹, Toshikatsu Kanazawa³ and Kazuhiko Hatta⁴, ¹Rheumatology, Hiroshima Clinic, Hiroshima, Japan, ²rheumatology., hiroshima clinic, Hiroshima, Japan, ³rheumatology, hiroshima clinic, hiroshima, Japan, ⁴Rheumatology, Hatta Clinic, Kure, Japan

Meeting: ACR/ARHP Annual Meeting 2017

Date of first publication: September 18, 2017

Keywords: Cardiovascular disease, rheumatoid arthritis (RA) and tofacitinib

Session Information

Date: Sunday, November 5, 2017

Title: Rheumatoid Arthritis – Small Molecules, Biologics and Gene Therapy Poster I: Comorbidities and Adverse Events; Efficacy and Safety of Small Molecules

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Rheumatologists need to develop primary prevention strategies for cardiovascular disease (CVD) in rheumatoid arthritis (RA) patients. We reported tofacitinib (Tofa) plus methotrexate improved left ventricular mass index (LVMI) in patients with rheumatoid arthritis. How about tofacitinib monotherapy? To study the effect of Tofa monotherapy (MTX) on LV morphology and function in conventional DMARDs resistant active RA patients, in a cohort study design.

Methods: RA patients were eligible if they had active disease despite treatment with conventional DMARDs. Consecutive 21 patients with moderate to severe active RA patients (DAS28>3.2) despite conventional DMARDs were received Tofa monotherapy. LV morphology and function was assessed with cardio-MRI at baseline and 24 weeks follow-up. Cardiovascular risk factors and clinical data were collected at regular visits.

Results: 19 patients completed 24 weeks. Left ventricular mass index (LVMI) was attenuated significantly by Tofa (week 0-week24, −10.02±4.8 g/m²; p=0.02). Cardiac output (CO) was attenuated significantly by Tofa (week 0-week24,-0.65 ± 0.9l/min). DAS28 and CRP improved significantly by Tofa (week 0-week24; DAS28: -2.16±0.95; CRP: 15.1±5.7 mg/l) (p<0.05). Surprisingly, the change of disease activity (DAS 28 and CRP) is no correlation with the change of LVMI or CO in this study. Observationally, 2 cases significantly improved right ventricular mass as well as left ventricular mass (20 % improved right ventricular mass index from baseline).

Conclusion: Tofa monotherapy improved LVMI and CO in active RA despite MTX. Tofa monotherapy improves LVMI and CO independently of its effects on disease activity. Tofa might be improved right ventricular mass. JAK-STAT pathway might be an important role of LV hypertrophy. Tofa, JAK-STAT pathway blocking, may prevent cardiovascular morbidity and mortality in RA.

References: 1) Tofacitinib improves left ventricular mass and cardiac output in patients with rheumatoid arthritis Kume K, et al. presentation at annual meeting of EULAR 2017

2) Etanercept normalises left ventricular mass in patients with rheumatoid arthritis. Claire Immediato Daïen et al. Annals of the rheumatic diseases. 2013 Jun; 72(6); 881-7. doi: 10.1136/annrheumdis-2012-201489.

Disclosure: K. Kume, None; K. Amano, None; S. Yamada, None; T. Kanazawa, None; K. Hatta, None.

To cite this abstract in AMA style:

Kume K, Amano K, Yamada S, Kanazawa T, Hatta K. Tofacitinib Monotherapy Improves Left Ventricular Mass and Cardiac Output in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/tofacitinib-monotherapy-improves-left-ventricular-mass-and-cardiac-output-in-patients-with-rheumatoid-arthritis/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/tofacitinib-monotherapy-improves-left-ventricular-mass-and-cardiac-output-in-patients-with-rheumatoid-arthritis/