Background Cardiovascular disease (CVD) risk scores incorporating measures of inflammation such as the Reynolds risk score (RRS) may be more appropriate to predict CVD risk in patients (pts) with rheumatoid arthritis (RA), even though not yet validated for RA pts.
Objectives To investigate the effect of biologic DMARDs on lipids and the RRS
Methods Pts with at least moderate disease activity (CDAI >10) initiating a biologic DMARD participated in a comparative effectiveness trial (CERTAIN) nested within CORRONA. Characteristics, including lipid values, high sensitivity C-reactive protein (hsCRP) and RRS in pts initiating a TNF-α inhibitor (TNFi) or non-TNFi (rituximab [RTX], abatacept [ABT] or tocilizumab [TCZ]), were measured at baseline and 3 months later. Mixed models examined the association of individual biologics with changes in lipid levels, log hsCRP and RRS after 3 months of therapy.
Results 779 initiations of a biologic were analyzed. Baseline characteristics: 75.9% women, 86.3% Caucasian, 65.5% seropositive. Mean ± SD age was 55.9 ± 13.3 years, RA disease duration 8.8 ± 9.5 years; CDAI 28.6 ± 12.7. 35.9% of pts were biologic naïve and 24.6% on anti-hyperlipidemic therapy. History of prior CVD was present in 8.0% of pts; 4.1% had diabetes mellitus and 41% were obese (BMI>30). Table 1 shows lipid levels, log hsCRP and RRS at baseline and adjusted changes after 3 months. Pts initiating TCZ had a significant increase in total cholesterol, LDL, triglycerides (TG) and a significant decrease in log hsCRP compared with patients initiating TNFi. Change in log hsCRP for patients initiating ABT was statistically different as compared to patients initiating TNFi. Baseline RRS and 3 month change was similar across all biologics.
Conclusions The impact of lipid changes on CVD risk should be considered in light of the burden of inflammation in pts with RA. Moderate increases in lipid levels may not necessarily translate to an increased CVD risk as captured by RRS.
References Ridker PM et al. C-reactive protein and parental history improve global cardiovascular risk prediction: the Reynolds Risk Score for men. Circulation. 2008. 25;118(22):2243-51.
Disclosure of Interest D. Pappas Employee of: Columbia University, Paid instructor for: Novartis, A. John Employee of: Genentech, Inc, J. Kremer Shareholder of: CORRONA, Employee of: CORRONA, G. Reed Consultant for: University of Massachusetts Medical School, Employee of: CORRONA, J. Greenberg Shareholder of: CORRONA, Consultant for: AstraZeneca, CORRONA, Novartis, Pfizer, A. Shewade Employee of: Genentech, Inc, D. Solomon Grant/research support from: Amgen, Lilly, CORRONA, J. Curtis Grant/research support from: Roche/Genentech, UCB, Janssen, CORRONA, Amgen, Pfizer, BMS, Crescendo, Abb Vie, Consultant for: Roche/Genentech, UCB, Janssen, CORRONA, Amgen, Pfizer, BMS, Crescendo, Abb Vie