Risk of ACS Significantly Reduced for RA Patients Treated with Tumor Necrosis Factor Inhibitors

A good response to tumor necrosis factor inhibitors taken to treat rheumatoid arthritis comes along with the added benefit of reduced risk of acute coronary syndrome, a study finds.

Patients who respond well to tumor necrosis factor inhibitors (TNFi) prescribed for the treatment of rheumatoid arthritis (RA) have a decreased risk of developing acute coronary syndrome (ACS), a recent Swedish study has found.

The study, which was presented at the annual meeting of the American College of Rheumatology in San Diego, examined the medical records of 7361 RA patients listed in the Swedish Biologics Register between 2001 and 2010 who had been on TNFi treatment for longer than 2 months. Information on inflammatory activity was collected at the start of the study and at 5 (plus or minus 3) months after therapy initiation, and European League Against Rheumatism (EULAR) response was measured at 5 months in 4931 patients. Each patient was matched with 5 general population referents from the Population Register for purposes of comparison.

Incident ACS was defined as a primary discharge diagnosis of myocardial infarction or unstable angina, or death due to myocardial infarction.

Approximately 38% of patients had a good EULAR response, 37% had a moderate EULAR response, and 25% had no response to biologic treatment with TNFi. Relative risk for ACS among disease response classes was compared with nonresponders and general population referents.

After 1 year, 33 cases of ACS were observed. During year 1 and 2 after exposure to TNFi, 59 ACS cases were observed. The authors concluded that a good EULAR response to TNFi treatment after 5 months was significantly associated with a decreased risk of ACS. In addition, during the 2 years after evaluation, patients who responded well to treatment had no significant increase in the risk of ACS compared with the general population referents.