Reducing cardiovascular risk with immunomodulators: a randomised active comparator trial among patients with rheumatoid arthritis. Issue 3 (30th November 2022)

• Record Type: Journal Article
• Authors: Solomon, Daniel H; Giles, Jon T; Liao, Katherine P; Ridker, Paul M; Rist, Pamela M; Glynn, Robert J; Broderick, Rachel; Lu, Fengxin; Murray, Meredith T; Vanni, Kathleen; Santacroce, Leah M; Abohashem, Shady; Robson, Philip M; Fayad, Zahi; Mani, Venkatesh; Tawakol, Ahmed; Bathon, Joan
• Other Names: author non-byline.; Ali Yousaf author non-byline.; Baker Joshua author non-byline.; Bolster Marcy B. author non-byline.; Bykerk Vivian author non-byline.; Charles-Schoeman Christina author non-byline.; Chu Cong-Qiu author non-byline.; Cohen Stanley author non-byline.; Curtis Jeffrey author non-byline.; Cush Jack author non-byline.; Downey Christina author non-byline.; Fallena Margarita author non-byline.; Firooz Nazanin author non-byline.; Freyne Brigid author non-byline.; Graf Jonathan author non-byline.; Greenwald Maria author non-byline.; Horowitz Diane author non-byline.; Husni Elaine author non-byline.; Kataria Rajesh author non-byline.; Keystone Edward author non-byline.; Kivitz Alan author non-byline.; Kremer Joel author non-byline.; Levin Robert author non-byline.; Lohr Kristine author non-byline.; Massarotti Elena author non-byline.; Matsumoto Alan author non-byline.; Mease Philip author non-byline.; Mendez Barbara author non-byline.; Miller Jeffrey author non-byline.; Moreland Larry author non-byline.; Nguyen Binh author non-byline.; Parks Deborah author non-byline.; Rigby William author non-byline.; Scher Jose author non-byline.; Schiopu Elena author non-byline.; Scholz Beth author non-byline.; Valenzuela Guillermo author non-byline.;
• Is Part Of: Annals of the rheumatic diseases. Volume 82:Issue 3(2023)
• Page Start: 324
• Page End: 330
• Publication Date: 2022-11-30
• Subjects: Arthritis, Rheumatoid -- Cardiovascular Diseases -- Tumor Necrosis Factor Inhibitors; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/ard-2022-223302
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Objective: Recent large-scale randomised trials demonstrate that immunomodulators reduce cardiovascular (CV) events among the general population. However, it is uncertain whether these effects apply to rheumatoid arthritis (RA) and if certain treatment strategies in RA reduce CV risk to a greater extent. Methods: Patients with active RA despite use of methotrexate were randomly assigned to addition of a tumour necrosis factor (TNF) inhibitor (TNFi) or addition of sulfasalazine and hydroxychloroquine (triple therapy) for 24 weeks. Baseline and follow-up 18 F-fluorodeoxyglucose-positron emission tomography/CT scans were assessed for change in arterial inflammation, an index of CV risk, measured as an arterial target-to-background ratio (TBR) in the carotid arteries and aorta. Results: 115 patients completed the protocol. The two treatment groups were well balanced with a median age of 58 years, 71% women, 57% seropositive and a baseline disease activity score in 28 joints of 4.8 (IQR 4.0, 5.6). Baseline TBR was similar across the two groups. Significant TBR reductions were observed in both groups—ΔTNFi: −0.24 (SD=0.51), Δtriple therapy: −0.19 (SD=0.51)—without difference between groups (difference in Δs: −0.02, 95% CI −0.19 to 0.15, p=0.79). While disease activity was significantly reduced across both treatment groups, there was no association with change in TBR (β=0.04, 95% CI −0.03 to 0.10). Conclusion: We found that addition of either a TNFi or triple therapy resulted in clinically important improvements in vascular inflammation. However, the addition of a TNFi did not reduce arterial inflammation more than triple therapy. Trial registration number: NCT02374021 .