Patients with rheumatoid arthritis (RA) receiving concomitant therapy with methotrexate (MTX) and biologic disease-modifying antirheumatic drugs (bDMARDs) were reported to have reduced risk for cardiovascular disease (CVD).
The findings of the study presented at the 2018 ACR/ARHP Annual Meeting, held in Chicago, reveals that an overall 23% reduction of CVD risk is associated with concomitant MTX use.
Fenglong Xie and associates conducted a retrospective cohort study using 2006-2015 Medicare claims data for RA patients.Follow-up commenced at initiation (index date) and concluded at the earliest occurrence of 1 of the following: (1) end of exposure of the specific bDMARD (days of supply with 90-day extension); (2) switch to another bDMARD or to tofacitinib; (3) CVD event; (4) death date; (5) loss of Medicare coverage; or (6) end of study.
MTX use was defined as follows: (1) concomitant MTX use, with a prescription for MTX within 120 days after the index date and (2) time-varying MTX, which denoted prescription date to prescription date plus days of supply without extension. A 90-day extension was added to days of supply, for sensitivity analysis. The primary study outcome was the composite of incident myocardial infarction, incident stroke, and fatal CVD.
A total of 88,255 DMARDS initiations (64,218 patients) were included in the study with a median age at initiation 64.6 years.
The key study findings included are:
- The crude incidence ratios (IRs) for CVD were 13.1 and 18.7 events per 1,000 person-years (PY) for RA patients with and without concomitant MTX respectively.
- The crude IRs for CVD were 12.1 and 17.9 events per 1,000 PY for RA patients with and without time-varying MTX respectively.
- P-value for interaction between concomitant MTX and background bDMARDS was 0.0189 and p-value for interaction between time-varying MTX and background bDMARDS was 0.0030.
- The contrast HRs for concomitant MTX ranged from 0.61 for golimumab initiators to 0.97 for adalimumab initiators.
- The contrast HRs for time-varying MTX ranged from 0.58 for certolizumab initiators to 0.90 for adalimumab initiators.
“Our observational study suggests an overall 23% reduction of CVD risk associated with concomitant MTX use. The effect sizes vary among background bDMARDS, ”write the authors.
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