Background The pathogenic mechanisms involved in increased CV complications in RA patients are multifactorial due to RA-related inflammation as well as the traditional risk factors affecting the general population.
Objectives To assess 10-year CV event risk in patients with RA at the baseline, 12 and 18 months after the initiation of treatment with Biologic DMARDs (BDMARDs).
Methods 215 patients with RA receiving biologic therapy (Etanercept, Adalimumab, Rituximab, Tocilizumab and Abatacept) were included in this study. The FRS was used for the assessment of the 10-year CV risk. The presence of CV risk factors was ascertained by a medical records review throughout the study. Paired t-test and Regression analyses before and after treatment with biologics were performed.
The mean age was 55.6 (12) years. The mean age at RA diagnosis was 41.6 (13.2) years with mean duration of RA 14.6 (8.6) years. 7 patients had MI and 5 TIA/Stroke prior to the study. 41 patients smoked at the baseline. 61 patients were on Lipid-lowering treatment, of them 31 (45%) started it after the initiation of the treatment with biologics. TJC and SJC were significantly reduced after 12 and 18 months of treatment. The mean TC not significantly increased from the baseline measures. HDL significantly increased at 12-month and not significantly at 18-month period. The AI was significantly reduced during the two follow-up periods. CRP, ESR and DAS28 were also significantly reduced from the baseline levels. Patients were grouped by their 10-year CVD risk level: 5.2% of men and 3.8% of women in an 18-month period lowered their risk from the high to the moderate/low. The overall risk of CVD was slightly reduced at 12-month but significantly at 18-month (from 11.5±9.4 to 10.7±8.9, p=0.011; 95%CI 0.18-1.36). 10-year CV event risk was significantly improved at 18-month in Tocilizumab (14.2±10.0 vs. 12.7±9.1; p=0.026; 95%CI 0.20-2.85) and Abatacept (12.7±10.3 vs. 10.6±9.8; p=0.011; 95%CI 0.53-3.64) cohorts.
Conclusions Our findings showed a trend in reducing a 10-year CV event risk over 18-month period. No CV event was observed during the study period. The results demonstrated a favorable effect of BDMARDs on the levels of atheroprotective HDL-C. Good control of the chronic inflammation by biologic DMARDs effectively decreased the intermittent disease activity and possibly played a pivotal role in reducing the risk for CV event in patients with RA.
Disclosure of Interest M. Khraishi Grant/research support from: Dr. Khraishi received non restricted educational grants from Hoffman-La Roche Canada, Amgen and Pfizer Canada, and Abbott Canada, R. Aslanov: None Declared