The use of combination TNF-inhibitor-methotrexate therapy in people with rheumatoid arthritis was associated with a risk of heart attack that was reduced by 80 percent in comparison with those using methotrexate alone, according to research presented recently at the American College of Rheumatology Annual Scientific Meeting in Boston, Mass.
Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of many joints. An estimated 2.1 million Americans have RA, most of them women. Although joints are the principal body parts affected by RA, inflammation can develop in other organs as well. Heart attacks, resulting from inflammation of the coronary vessels, are more common in RA sufferers.
Researchers recently studied the risk of heart attack in patients using a TNF-inhibitor (a drug that blocks cytokines and can reduce pain, morning stiffness and swollen joints in RA), methotrexate (a drug used to treat RA by blocking the metabolism of cells) and other DMARDs (a category of drugs used in many autoimmune disorders to slow down the disease progression) in a large population of patients with RA—many of whom were also taking aspirin.
Using data obtained from MediCal, California’s Medicaid program, researchers studied patients over the age of 18, suffering from RA, who were treated with TNF-inhibitors, methotrexate, or other DMARDs, over six-and-a-half years.
A total of 19,233 patients with RA were identified. The patients’ mean age was 55 years, and approximately 79 percent were women. Of these patients, 13,383 took methotrexate; 14,958 took other DMARDS; and 4,943 took TNF-inhibitors. Exposure to TNF-inhibitors (taken alone or in combination with methotrexate) was compared to taking methotrexate alone.
During the study period, 441 patients suffered heart attacks, of which eight percent were fatal.
Researchers found that patients on a combination of TNF-inhibitors with methotrexate treatment had a heart attack risk of only 20 percent of the risk compared to patients taking methotrexate alone.
However, there was no statistical difference seen among patients who were taking TNF-inhibitors alone, TNF-inhibitors with other DMARDs, other DMARD therapies without methotrexate, or a combination of DMARDs and methotrexate.
“TNF-inhibitor therapy, in combination with methotrexate, dramatically reduces the risk of heart attacks in patients with RA and should be seriously considered— especially in high-risk patients,” said Gurkirpal Singh, MD; adjunct clinical professor of medicine, division of gastroenterology and hepatology, Stanford University School of Medicine; chief science officer, Institute of Clinical Outcomes Research and Education; and an investigator in the study.
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