Background Patients with rheumatoid arthritis (RA) have an increased cardiovascular risk. We should have strategies for primary cardiovascular prevention in RA. Tofacitinib (Tofa) could possibly play a role in up-regulating levels of serum cholesterol1. But there is no evidence of CV risk management about Tofa.
Objectives To examine the effect of Tofa plus methotrexate (MTX) on arterial stiffness in MTX resistant RA patients in a cohort study design.
Methods 18 RA patients with moderate to severe active disease despite MTX treatment (disease activity score: DAS28>3.2) were received Tofa plus MTX. All patients have no previous history of CV. Arterial stiffness was assessed with cardio-ankle vascular index (CAVI) and augmentation index corrected for a heart rate of 75 beats per minute (AIx@75) at baseline and 24 weeks follow-up. Clinical data were collected at regular visits. CAVI is very similar to pulse wave velocity (PWV), and CAVI measures arterial wall stiffness independent of blood pressure and it is superior to brachial ankle PWV as an index of arterial stiffness2.
Results Treatment with Tofa (10.68±1.77 and 9.48±1.28%; p=0.016), attenuated the CAVI significantly from baseline to 24 weeks follow up. Treatment with Tofa (36.7±8.6, 32.2±3.6%; p=0.018) attenuated the Aix@75 significantly from baseline to 24 weeks follow up. DAS 28-ESR score improved significantly from baseline to 24 weeks (5.11±1.33, 2.43±1.43: p=0.01). On the other hand, fasting serum total cholesterol TC was significantly increased from baseline to follow-up at 24 weeks (211±21.2mg/dL, 232±24.2mg/dL, p=0.03).
Conclusions These findings suggest that combination therapy, Tofa with MTX not only reduced RA disease activity but also limited vascular damage in patients with MTX resistant active RA.
Kremer J. et al. Tofacitinib in combination with nonbiologic disease-modifying antirheumatic drugs in patients with active rheumatoid arthritis: a randomized trial. Ann Intern Med. 2013 Aug 20;159(4):253-61.
Takaki A et al. Cardio-ankle vascular index is superior to brachial-ankle pulse wave velocity as an index of arterial stiffness. Hypertens Res.2008 Jul; 31(7):1347-55
Acknowledgements We thank for Hiroshi Komori and Hiroyuki Ohta at Hiroshima Clinic for aquiring data.
Disclosure of Interest None declared