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. 2018 Aug 7;20(1):171.
doi: 10.1186/s13075-018-1669-x.

Biologics and cardiovascular events in inflammatory arthritis: a prospective national cohort study

Joshua L Lee  1 , Premarani Sinnathurai  2   3   4 , Rachelle Buchbinder  5   6 , Catherine Hill  7   8 , Marissa Lassere  9   10 , Lyn March  1   11   12
Affiliations

Biologics and cardiovascular events in inflammatory arthritis: a prospective national cohort study

Joshua L Lee et al. Arthritis Res Ther. .

Abstract

Background: Inflammatory arthritides including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are associated with increased risk of cardiovascular disease. This process may be driven by systemic inflammation, and the use of tumour necrosis factor (TNF) inhibitors could therefore potentially reduce cardiovascular risk by reducing this inflammatory burden. The aims of this study were to evaluate whether the risk of cardiovascular events (CVEs) in patients with inflammatory arthritis is associated with treatment with anti-TNF therapy, compared with other biologics or non-biologic therapy, and to compare the CVE risk between participants with RA, PsA and AS.

Methods: Data from consecutive participants in the Australian Rheumatology Association Database with RA, PsA and AS from September 2001 to January 2015 were included in the study. The Cox proportional hazards model using the counting process with time-varying covariates tested for risk of having CVEs, defined as angina, myocardial infarction, coronary artery bypass graft, percutaneous coronary intervention, other heart disease, stroke/transient ischaemic attack or death from cardiovascular causes. The model was adjusted for age, sex, diagnosis, methotrexate use, prednisone use, non-steroidal anti-inflammatory use, smoking, alcohol consumption, hypertension, hyperlipidaemia, diabetes and functional status (Health Assessment Questionnaire Disability Score).

Results: There were 4140 patients included in the analysis, totalling 19,627 patient-years. After multivariate adjustment, the CVE risk was reduced with anti-TNF use (HR 0.85, 95% CI 0.76-0.95) or other biologic therapies (HR 0.81, 95% CI 0.70-0.95), but not in those who had ceased biologic therapy (HR 0.96, 95% CI 0.83-1.11). After adjustment, no significant difference in CVE risk was observed between participants with RA and PsA (HR 0.92, 95% CI 0.77-1.10) or AS (HR 1.14, 95% CI 0.96-1.36).

Conclusions: Current biologic use was associated with a reduction in major CVEs. No reduction in CVE risk was seen in those who had ceased biologic therapy. After adjustment, the CVE risk was not significantly different between RA, AS or PsA.

Keywords: Ankylosing spondylitis; Biologicals; Cardiovascular disease; Psoriatic arthritis; Rheumatoid arthritis.

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Conflict of interest statement

Ethical approval and consent to participate

Twenty ethics committees and organisations have granted approval for the ARAD across each state in Australia (New South Wales: Northern Sydney Local Health District, Cancer Council NSW; Victoria: Cabrini Health, Monash University, Royal Children’s Hospital, St Vincent’s Hospital, Cancer Council Victoria; Queensland: Queensland Government; South Australia: The South Australian Department of Health and Ageing, Women’s and Children’s Hospital SA Health Network; Western Australia: Department of Health WA, Fiona Stanley Hospital, Rockingham General Hospital, Royal Perth Hospital, Southern Metropolitan Health Service, Government of WA; Tasmania: Tasmania Health, University of Tasmania; Australian Capital Territory: ACT Health and Community Care). Approval has also been granted by the Australian Institute of Health and Welfare, the Australian Government Department of Health and the Department of Defence and Veterans’ Affairs, the cancer registry in each state (New South Wales, Victoria, Queensland, South Australia, Western Australia, Tasmania, Australian Capital Territory, Northern Territory) and the National Cancer Statistics Clearing House. All participants provide informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram for participant inclusion from the ARAD. ARAD Australian Rheumatology Association Database, AS ankylosing spondylitis, PsA psoriatic arthritis, RA rheumatoid arthritis
See this image and copyright information in PMC

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