Treat-to-target approach for RA has cardiovascular benefits

Rheumatoid arthritis patients have a significantly reduced risk of cardiovascular events if their disease is under control, based on an analysis of data from the CORRONA registry.

Investigators led by Dr. Daniel H. Solomon from Brigham and Women’s Hospital in Boston used longitudinal data from almost 25,000 RA patients who were tracked for a median of 2.7 years to find a 21% reduction (95% confidence interval, 13%-29%) in the risk of a composite outcome of the first confirmed myocardial infarction, stroke, or CV death event for each 10-point decline in the Clinical Disease Activity Index and a 53% reduction (95% confidence interval, 30%-68%) from high disease activity to remission.

“These results add significant new information regarding the importance of sustained control of RA disease activity, not only for improvement in pain and function, but also for reduced CV risk,” the authors wrote (Arthritis Rheumatol. 2015 [doi:10.1002/art.39098]).

The findings held true even after researchers adjusted for the use of immunomodulatory treatment, suggesting that controlling disease activity may be a more important management strategy than use of an immunomodulator, at least in the context of preventing CV events, they said.

“This is a hypothesis worth testing especially as enthusiasm grows for use of combination synthetic DMARDs [disease-modifying antirheumatic drugs],” they wrote.

Another clinical implication of the findings was that the adoption of a treat-to-target strategy in RA might be beneficial not only because of the observed improvement in pain and function but also because of a reduction in CV risk, they said.

“While these findings should not be interpreted to mean that traditional risk factors are not important, they do support the current RA recommendations for treating to low disease activity or remission,” they added.

In an accompanying editorial, Dr. Michael T. Nurmohamed of the department of rheumatology at VU University, Amsterdam, agreed with the authors that controlling disease activity (from a CV point of view) counted more than the drug used to achieve the low disease activity state or remission (Arthritis Rheumatol. 2015 [doi:10.1002/art.39096]).

“As inflammation plays a pivotal role in atherosclerotic disease it is not surprising that antirheumatic drugs such as methotrexate, the IL-1 inhibitor canakinumab and the IL-6 inhibitor tocilizumab are presently investigated in several trials as secondary prevention for recurrent CV events in ‘general population’ patients,” he said.

Although the current state-of-art treatment goals for patients with RA appear also to improve the CV risk of patients, it is important to realize there is still no evidence from randomized trials that RA treatment itself reduces CV risk. And despite the fact that rheumatologists know that traditional CV risk factors are important in RA, the management of CV risk factors in daily clinical practice are still poor, he said.

“Another challenge for the next years is to fulfill this unmet need for effective CV risk management implementation strategies,” he concluded.

The researchers declared receiving financial support from various pharmaceutical companies, but none were specifically linked to the current study. The study was supported by CORRONA, which has received subscription fees from a variety of pharmaceutical companies in the past 2 years, but none relating specifically to this study.

Rheumatoid arthritis patients have a significantly reduced risk of cardiovascular events if their disease is under control, based on an analysis of data from the CORRONA registry.

Investigators led by Dr. Daniel H. Solomon from Brigham and Women’s Hospital in Boston used longitudinal data from almost 25,000 RA patients who were tracked for a median of 2.7 years to find a 21% reduction (95% confidence interval, 13%-29%) in the risk of a composite outcome of the first confirmed myocardial infarction, stroke, or CV death event for each 10-point decline in the Clinical Disease Activity Index and a 53% reduction (95% confidence interval, 30%-68%) from high disease activity to remission.

“These results add significant new information regarding the importance of sustained control of RA disease activity, not only for improvement in pain and function, but also for reduced CV risk,” the authors wrote (Arthritis Rheumatol. 2015 [doi:10.1002/art.39098]).

The findings held true even after researchers adjusted for the use of immunomodulatory treatment, suggesting that controlling disease activity may be a more important management strategy than use of an immunomodulator, at least in the context of preventing CV events, they said.

“This is a hypothesis worth testing especially as enthusiasm grows for use of combination synthetic DMARDs [disease-modifying antirheumatic drugs],” they wrote.

Another clinical implication of the findings was that the adoption of a treat-to-target strategy in RA might be beneficial not only because of the observed improvement in pain and function but also because of a reduction in CV risk, they said.

“While these findings should not be interpreted to mean that traditional risk factors are not important, they do support the current RA recommendations for treating to low disease activity or remission,” they added.

In an accompanying editorial, Dr. Michael T. Nurmohamed of the department of rheumatology at VU University, Amsterdam, agreed with the authors that controlling disease activity (from a CV point of view) counted more than the drug used to achieve the low disease activity state or remission (Arthritis Rheumatol. 2015 [doi:10.1002/art.39096]).

“As inflammation plays a pivotal role in atherosclerotic disease it is not surprising that antirheumatic drugs such as methotrexate, the IL-1 inhibitor canakinumab and the IL-6 inhibitor tocilizumab are presently investigated in several trials as secondary prevention for recurrent CV events in ‘general population’ patients,” he said.

Although the current state-of-art treatment goals for patients with RA appear also to improve the CV risk of patients, it is important to realize there is still no evidence from randomized trials that RA treatment itself reduces CV risk. And despite the fact that rheumatologists know that traditional CV risk factors are important in RA, the management of CV risk factors in daily clinical practice are still poor, he said.

“Another challenge for the next years is to fulfill this unmet need for effective CV risk management implementation strategies,” he concluded.

The researchers declared receiving financial support from various pharmaceutical companies, but none were specifically linked to the current study. The study was supported by CORRONA, which has received subscription fees from a variety of pharmaceutical companies in the past 2 years, but none relating specifically to this study.

Rheumatoid arthritis patients have a significantly reduced risk of cardiovascular events if their disease is under control, based on an analysis of data from the CORRONA registry.

Investigators led by Dr. Daniel H. Solomon from Brigham and Women’s Hospital in Boston used longitudinal data from almost 25,000 RA patients who were tracked for a median of 2.7 years to find a 21% reduction (95% confidence interval, 13%-29%) in the risk of a composite outcome of the first confirmed myocardial infarction, stroke, or CV death event for each 10-point decline in the Clinical Disease Activity Index and a 53% reduction (95% confidence interval, 30%-68%) from high disease activity to remission.

“These results add significant new information regarding the importance of sustained control of RA disease activity, not only for improvement in pain and function, but also for reduced CV risk,” the authors wrote (Arthritis Rheumatol. 2015 [doi:10.1002/art.39098]).

The findings held true even after researchers adjusted for the use of immunomodulatory treatment, suggesting that controlling disease activity may be a more important management strategy than use of an immunomodulator, at least in the context of preventing CV events, they said.

“This is a hypothesis worth testing especially as enthusiasm grows for use of combination synthetic DMARDs [disease-modifying antirheumatic drugs],” they wrote.

Another clinical implication of the findings was that the adoption of a treat-to-target strategy in RA might be beneficial not only because of the observed improvement in pain and function but also because of a reduction in CV risk, they said.

“While these findings should not be interpreted to mean that traditional risk factors are not important, they do support the current RA recommendations for treating to low disease activity or remission,” they added.

In an accompanying editorial, Dr. Michael T. Nurmohamed of the department of rheumatology at VU University, Amsterdam, agreed with the authors that controlling disease activity (from a CV point of view) counted more than the drug used to achieve the low disease activity state or remission (Arthritis Rheumatol. 2015 [doi:10.1002/art.39096]).

“As inflammation plays a pivotal role in atherosclerotic disease it is not surprising that antirheumatic drugs such as methotrexate, the IL-1 inhibitor canakinumab and the IL-6 inhibitor tocilizumab are presently investigated in several trials as secondary prevention for recurrent CV events in ‘general population’ patients,” he said.

Although the current state-of-art treatment goals for patients with RA appear also to improve the CV risk of patients, it is important to realize there is still no evidence from randomized trials that RA treatment itself reduces CV risk. And despite the fact that rheumatologists know that traditional CV risk factors are important in RA, the management of CV risk factors in daily clinical practice are still poor, he said.

“Another challenge for the next years is to fulfill this unmet need for effective CV risk management implementation strategies,” he concluded.

The researchers declared receiving financial support from various pharmaceutical companies, but none were specifically linked to the current study. The study was supported by CORRONA, which has received subscription fees from a variety of pharmaceutical companies in the past 2 years, but none relating specifically to this study.