Biologics May Cut Heart Risk in RA

Biologic therapy appears to lower the risk of cardiovascular disease (CVD) significantly among rheumatoid arthritis (RA) patients over two years – and also may reduce overall disease activity, say researchers from Newfoundland.

A prospective study of more than 200 patients showed that biologics lowered their CVD risk by almost 12% over 24 months, the researchers reported at the recent annual meeting of the American College of Rheumatology in San Diego.

Levels of risk were defined by 10-year Framingham Risk Scores (FRS):  20% or greater risk of a cardiovascular event was defined as high risk; <10% according to FRS was called low risk and levels inbetween were defined as moderate.

RA patients are known to have an elevated heart risk, dueboth  to systemic inflammation and to conventional CVD risk factors, such as smoking (19% of the study patients smoked at baseline) and hypertension (found in 30.9% of the group).

Among the RA study patients, 73% (n=161) were women (mean age 56), with an average disease duration of 14.5 years. They were treated with adalimumab (Humira), abatacept (Orencia), tocilizumab (Actemra), etanercept (Enbrel), and rituximab (Rituxan). Sixty-five patients had been on cholesterol-lowering medications at baseline and 31 started after initiating biologics.

Over the two-year period, more women than men reduced their risk level. Among women, 3.7% reduced their risk level, moving from high or moderate to low. Only 1.7% of men in the study were at a lower risk level by the end of analysis, having shifted from high to moderate risk.

Overall, the 10-year CVD risk reduced from 12.5% at baseline to 11.9% at 24 months. All subjects achieved lower total cholesterol and “bad” low-density lipoprotein cholesterol (LDL) while increasing thier “good” high-density cholesterol (HDL). Most importantly, the serum atherogenic index (AI), the ratio of total cholesterol to HDL, dipped from 4.6 to 3.8, going from average to low risk in some cases.

Patients also had significant decreases in 28-joint disease activity (DAS28), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), as well as tender and swollen joint counts.

“Not only did many patients achieve remission or low disease activity, but we significantly reduced their Framingham risk scores and their risk of actual cardiovascular events,” said lead author Majed Khraishi MD, medical director of rheumatology at Nexus Clinical Research at the Memorial University of Newfoundland.

“All of the biologics reduced risk, but abatacept and tocilizumab lowered cardiovascular risk the most. That was a surprise and we don’t know the exact reason,” Khraishi added in an interview. “But in the end, we feel that if you treat patients effectively, if you lower inflammation, you also reduce their cardiovascular risk in real-life, clinical practice terms.”