Risk of Incident Cardiovascular Events with Disease-Modifying Antirheumatic Drugs Combinations Among Adult Patients with Rheumatoid Arthritis: A Nested Case-Control Study

Speaker(s)

Huang Y1, Agarwal S2, Chatterjee S3, Chen H4, Johnson ML5, Aparasu RR5
1Department of Pharmacy Administration, University of Mississippi, Oxford, MS, USA, 2Baylor College of Medicine, Houston, TX, USA, 3Boehringer-Ingelheim, Ridgefield, CT, USA, 4College of Pharmacy, University of Houston, Houston, TX, USA, 5University of Houston, College of Pharmacy, Houston, TX, USA

Presentation Documents

OBJECTIVES: Disease-modifying antirheumatic drugs (DMARDs) are the cornerstone of rheumatoid arthritis (RA) treatment. DMARDs targeting inflammation for disease control could reduce cardiovascular (CV) risk; however, each DMARD class with unique mechanistic pathways may have differential CV risk. This study examined the risk of CV disease (CV) associated with DMARDs in RA.

METHODS: This nested case-control study used the MarketScan database (2012-2014), involving adult RA patients (aged ³18 years) initiating either a conventional synthetic (cs) DMARD, biologic DMARD, or targeted synthetic (ts) DMARD between Jan 1, 2013, and Dec 31, 2014 (cohort entry) and had no CV history. Cases were individuals with incident CV events identified using diagnosis codes or procedure codes from medical claims. For each case, ten age and sex-matched controls were selected using the incident density sampling with replacement. DMARD exposure was measured 90 days before the event date. Conditional logistic regression examined the CV risk associated with DMARDs in combination treatment or individual use, with reference to Methotrexate (MTX) monotherapy, adjusting for baseline confounders. Subgroup analyses were performed separately in DMARDs combination therapy users or individual DMARDs users, respectively.

RESULTS: In total, 270 cases of incident CV events and 2,700 controls were included (mean [standard deviation (SD)] age: 54 [8]; 75.6% women). The commonly prescribed types of DMARDs therapies were csDMARDs monotherapy (n=795, 27.04%), followed by TNFi monotherapy (n=367, 12.48%), TNFi in combination with MTX (n=314, 10.68%). Compared with MTX monotherapy, overall use of DMARDs agents was not associated with the risk of CV, including various types of DMARDs combination regimens. The findings were similar across subgroup analyses.

CONCLUSIONS: The study found no differential risk of CV events with DMARDs in combination therapy or monotherapy compared to MTX monotherapy in patients with RA.

Code

EPH21

Disease

Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)