Tumor Necrosis Factor α Inhibitor Use and Decreased Risk for Incident Coronary Events in Rheumatoid Arthritis

Abstract

Objective: To determine the association of tumor necrosis factor (TNF)‐α inhibitors with risk for cardiovascular disease (CVD) in rheumatoid arthritis (RA) patients. Methods: A retrospective cohort of 2101 incident RA patients was established. Medication exposure was categorized in the following groups: TNF‐α inhibitors alone or in combination with methotrexate (aTNF); methotrexate alone or in combination with other non‐biological DMARDs (MTX); and non‐methotrexate, non‐biological DMARDs (reference). Primary outcome was adjudicated incident coronary artery disease (CAD), defined as myocardial infarction, unstable angina or coronary revascularization procedure. Secondary outcome was adjudicated incident cardiovascular disease (CVD), defined as a composite of CAD, stroke, transient ischemic attack, abdominal aortic aneurysm, peripheral arterial disease or arterial revascularization procedure. Cox regression models were used to calculate the hazard for CAD and CVD for aTNF and MTX groups compared to the reference group. Results: There were 46 incident CAD and 82 incident CVD events. Adjusting for covariates associated with CAD and CVD, the hazard for incident CAD was 0.45 (95% CI 0.21‐0.96) for aTNF and 0.54 (0.27‐1.09) for MTX compared to the reference group. Use of TNF‐α inhibitors for >16.1 months was associated with relative risk for CAD of 0.18 (0.06‐0.50) and for CVD of 0.31 (0.15‐0.65) compared to the reference group. A similar trend was seen with MTX use although not significant. Conclusion: Use of TNF‐α inhibitors is associated with a decreased risk for CAD in RA; the risk decreases further with longterm use. This should be considered when weighing the risks versus benefits of these medications. © 2013 American College of Rheumatology.