One-third of patients switch, end DMARDs after cardiovascular event
More than 30% of patients with rheumatoid arthritis, psoriatic arthritis or psoriasis either switched or discontinued their diseasemodifying antirheumatic drug treatment following a cardiovascular event, according to findings published in Arthritis Care and Research.
“After a [cardiovascular] event in patients with RA, PsA, or [psoriasis], adverse events may be more likely to occur and to have serious clinical consequences, or DMARDs may be contraindicated because of organ dysfunction resulting from the [cardiovascular] event,” Jeffrey A. Sparks, MD, MMSc, of Brigham and Women’s Hospital, Harvard Medical School, and colleagues wrote. “However, DMARD therapy may be required for underlying rheumatic disease control. Moreover, recent data support the potential benefit of immunomodulators in patients who have experienced a [cardiovascular] event.”
To analyze DMARD therapies — including conventional synthetic and biologic variations of the treatment — and determine the risk for subsequent cardiovascular events among patients with RA, PsA and psoriasis following an initial event, the researchers conducted a retrospective cohort study of information in the MarketScan claims databases. Focusing on the nationwide Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases, the researchers identified 10,254 patients with either RA, PsA or psoriasis.
Each patient had experienced an initial cardiovascular event — defined as acute myocardial infarction, stroke or coronary revascularization — while receiving either TNF inhibitor biologic DMARDs, non-TNF inhibitor biologic DMARDs or conventional synthetic DMARDs. From Jan. 1, 2006, through June 30, 2015, Sparks and colleagues evaluated DMARD treatment patterns follow the initial cardiovascular event, and the rates of subsequent events. In addition, they studied the predictors of DMARD discontinuation and risk factors for future events using Cox regression.
According to the researchers, among the 10,254 patients included in the study, 15.3% discontinued and 15.5% switched their DMARD treatment following their initial cardiovascular event. Independent predictors of DMARD discontinuation included a diagnosis of psoriasis, renal disease, hypertension, heart failure, diabetes mellitus, older age and baseline treatment with conventional synthetic DMARDs or non-TNF inhibitor biologic DMARDs. Incidence rates for subsequent cardiovascular events were 75.2 per 1,000 patient years for those receiving TNF-inhibitor biologic DMARDs, 83.6 for conventional synthetic DMARDs and 122.4 for non-TNF-inhibitor biologic DMARDs. The researchers also noted that baseline RA and heart failure were independently associated with increased risk for future cardiovascular events.
“Patients with RA, PsA, or [psoriasis] remain at high risk for a subsequent [cardiovascular] event following an initial [cardiovascular] event,” Sparks and colleagues wrote. “Our study suggests that DMARD therapy for the underlying RA, PsA, or [psoriasis] does not appear to affect the risk for subsequent [cardiovascular] events, and clinicians should carefully consider continuing DMARD therapy as well as appropriate therapies for [cardiovascular] disease.” – by Jason Laday
Disclosure: Sparks reports research grants from the NIH, the Rheumatology Research Foundation and Amgen, as well as consulting fees from Optum. Please see the study for all other authors’ relevant financial disclosures.