Immunology and Biotherapies

An evaluation of risk factors for major adverse #cardiovascular events during #tocilizumab therapy http://t.co/EymLTiXiv1 #rheum

 

Abstract

Objective. To explore associations of baseline and on-treatment lipid levels, inflammation, and rheumatoid arthritis (RA) disease activity with risk for major adverse cardiovascular events (MACE) in tocilizumab-treated RA patients.

Methods. In retrospective post hoc analyses, data were pooled from 3986 adults with moderate to severe RA administered ≥1 dose of tocilizumab 4 or 8 mg/kg intravenously every 4 weeks in randomized controlled trials and extension studies. Cox proportional hazards modeling was used to evaluate associations among baseline characteristics and posttreatment initiation variables (week 24) and change from baseline to week 24 disease activity and laboratory values, with risk for future MACE during extended follow-up.

Results. There were 50 independently adjudicated cases of MACE during 14,683 patient-years (PY) of follow-up (0.34 MACE/100 PY). At baseline, age, history of cardiac disorders, disease activity score using 28 joints (DAS28), and total cholesterol/high-density lipoprotein ratio were independently (P<0.05 for all) associated with MACE in multivariable models. On treatment, higher DAS28 scores and swollen and tender joint counts at week 24 were associated with future MACE. In separate models, greater reductions in DAS28 score and joint counts from baseline to week 24 were inversely associated with future MACE; changes in lipid parameters were not statistically significantly associated with risk for MACE.

Conclusion. As in the general population, an association was observed between baseline total cholesterol/high-density lipoprotein ratio and increased risk for MACE. Risk for on-treatment MACE, however, was found to be associated with control of disease activity but not lipid changes. Larger studies are needed to confirm these findings. © 2014 American College of Rheumatology.

Via Krishan Maggon