RT Journal Article
SR Electronic
T1 Reducing cardiovascular risk with immunomodulators: a randomised active comparator trial among patients with rheumatoid arthritis
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 324
OP 330
DO 10.1136/ard-2022-223302
VO 82
IS 3
A1 Daniel H Solomon
A1 Jon T Giles
A1 Katherine P Liao
A1 Paul M Ridker
A1 Pamela M Rist
A1 Robert J Glynn
A1 Rachel Broderick
A1 Fengxin Lu
A1 Meredith T Murray
A1 Kathleen Vanni
A1 Leah M Santacroce
A1 Shady Abohashem
A1 Philip M Robson
A1 Zahi Fayad
A1 Venkatesh Mani
A1 Ahmed Tawakol
A1 Joan Bathon
A1 ,
YR 2023
UL http://ard.bmj.com/content/82/3/324.abstract
AB 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 18F-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.Data are available in a public, open access repository. Data will be deposited to the appropriate NIH repository. We anticipate that the data will become available to qualified investigators through the NIH during summer 2023.