Are CVD Risk Factors Associated With Rheumatoid Arthritis Treatment Failure?

Having multiple risk factors for cardiovascular disease (CVD) may increase the risk of rheumatoid arthritis treatment failure, according to a study in ACR Open Rheumatology.

Noting the association between rheumatoid arthritis and CVD, the authors sought to investigate the relationship between the presence of CVD risk factors and retention of biologic disease-modifying antirheumatic drugs (DMARDs) or targeted-synthetic DMARDs (DMARDs). The study included 872 patients, who were grouped according to the baseline number of CVD risk factors (0, 1, or ≥2).

The primary outcome was time-to-discontinuation of therapy, and secondary outcomes were discontinuation for primary failure, secondary failure, or adverse events. In total, 58% of patients discontinued their antirheumatic medication after a median of 13 months.

The most common reason for treatment discontinuation was adverse events, in 133 patients. Seventy-two patients discontinued due to primary failure, and 133 patients discontinued due to secondary failure.

Patients who did not have any CVD risk factors tended to have significantly longer treatment duration compared with patients with ≥2 CVD risk factors (subdistribution hazard ratio [sHR] 1.32; 95% CI, 1.07–1.64; P=.01). The authors also noted a “higher magnitude of risk for combined treatment failure and secondary failure among those with ≥2 CVD risk factors.” After multivariable-adjusted analysis, no association was found between all-cause discontinuation and CVD risk factors, but a significant association was found between having at least 1 CVD risk factor and discontinuing treatment for secondary treatment failure.

In summary, “the results of our study indicate that the presence of multiple CVD risk factors may have an impact on the loss of treatment response to targeted therapies in rheumatoid arthritis,” the authors wrote. They called for further research to understand the underlying mechanisms associated with CVD comorbidity and treatment success.